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Characteristics of COVID-19 Patients Who Progress to Pneumonia on Follow-Up Chest Radiograph: 236 Patients from a Single Isolated Cohort in Daegu, South Korea

  • Ha Kyung Jung (Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Jin Young Kim (Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Mu Sook Lee (Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Ji Yeon Lee (Department of Internal Medicine, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Jae Seok Park (Department of Internal Medicine, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Miri Hyun (Department of Internal Medicine, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Hyun Ah Kim (Department of Internal Medicine, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Yong Shik Kwon (Department of Internal Medicine, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Sang-Woong Choi (Department of Internal Medicine, Daegu Dongsan Hospital, Keimyung University College of Medicine) ;
  • Sung Min Moon (Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine) ;
  • Young Joo Suh (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2020.05.08
  • Accepted : 2020.06.21
  • Published : 2020.11.01

Abstract

Objective: We investigated the prevalence of pneumonia in novel coronavirus disease 2019 (COVID-19) patients using chest radiographs to identify the characteristics of those with initially negative chest radiographs, who were positive for pneumonia on follow-up. Materials and Methods: Retrospective cohort data of 236 COVID-19 patients were reviewed. Chest radiography was performed on admission, with serial radiographs obtained until discharge. The 'positive conversion group' was defined as patients whose initial chest radiographs were negative but were positive for pneumonia during follow-up. Patients with initially positive chest radiographs were defined as the 'initial pneumonia group.' Patients with negative initial and follow-up chest radiographs were defined as the 'non-pneumonia group.' Clinical and laboratory findings were compared between groups, and predictors of positive conversion were investigated. Results: Among 236 patients, 108 (45.8%) were in the non-pneumonia group, 69 (29.2%) were in the initial pneumonia group, and 59 (25%) were in the positive conversion group. The patients in the 'initial pneumonia group' and 'positive conversion group' were older, had higher C-reactive protein (CRP) and lactate dehydrogenase levels, and lower absolute lymphocyte counts than those in the 'non-pneumonia group' (all p < 0.001). Among patients with negative initial chest radiographs, age ≥ 45 years (odds ratio [OR]: 3.93, 95% confidence interval [CI]: 1.76-8.75, p = 0.001), absolute lymphocyte count < 1500 cells/μL (OR: 2.25, 95% CI: 1.03-4.89, p = 0.041), and CRP > 0.5 mg/dL (OR: 3.91, 95% CI: 1.54-9.91, p = 0.004) were independent predictors for future development of pneumonia. Conclusion: More than a half of COVID-19 patients initially had normal chest radiographs; however, elderly patients (≥ 45 years of age) with abnormal laboratory findings (elevated CRP and low absolute lymphocyte counts) developed pneumonia on follow-up radiographs.

Keywords

Acknowledgement

This research was supported by the Bisa Research Grant of Keimyung University in 2020.

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