A Radiomics Based Approach Using Adrenal Gland and Periadrenal Fat CT Images to Fairly Allocate COVID-19 Health Care Resources

Background: COVID-19 disease severity is associated with endocrine system. We hypothesis radiomics features from the adrenal gland and periadrenal fat CT images can assess possibilities of disease exacerbation.Methods: A total of 1,245 patients (685 moderate and 560 severe patients) were enrolled in a retrospective study. We proposed 3D V-Net to segment adrenal glands in onset CT images automatically, and periadrenal fat was obtained using inflation operation around the adrenal gland. Next, we built a clinical model (CM), three radiomics models (adrenal gland model [AM], periadrenal fat model [PM], and fusion of adrenal gland and periadrenal fat model [FM]), and radiomics nomogram (RN) after radiomics features extracted.Findings: The auto-segmentation framework yielded a dice value of 0.79 in the training set. CM, AM, PM, FM, and RN obtained AUCs of 0.717, 0.716, 0.736, 0.760, and 0.833, respectively in the validation set. FM and RN had better predictive efficacy than CM (P < 0.0001) in the training set. RN showed that there was no significant difference in the validation set (mean absolute error [MAE] = 0.04) and test set (MAE = 0.075) between predictive and actual results. Decision curve analysis showed that if the threshold probability was more than 0.3 in the validation set or between 0.4 and 0.8 in the test set, it could gain more net benefits using RN than FM and CM.Interpretation: Radiomics features extracted from adrenal gland and periadrenal fat CT images are related to disease exacerbation in patients with COVID-19.Funding Information: The study was supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2019PT320003）; The Science and Technology Foundation of Guizhou Province (QKHPTRC[2019]5803); The Guiyang Science and Technology Project (ZKXM[2020]4); Beijing Medical and Health Foundation (YWJKJJHKYJJ-B20261CS) and Chongqing Science and Health Joint Medical Research Project (2021MSXM052).Declaration of Interests: The authors have declared that no conflict of interest exists.Ethics Approval Statement: This multicenter study was approved by the ethics committees of all participating hospitals (2020,NO.01). Because of its retrospective nature, the need to obtain informed consent in advance was waived. The study was performed according to the principles of the declaration of Helsinki.