Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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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
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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.

References

  1. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology 2020;200490
  2. Revel MP, Parkar AP, Prosch H, Silva M, Sverzellati N, Gleeson F, et al. COVID-19 patients and the radiology department - advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI). Eur Radiol 2020;1-7
  3. Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol 2020;21:494-500 https://doi.org/10.3348/kjr.2020.0132
  4. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance 13 March 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf. Accessed April 13, 2020
  5. Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S, et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the fleischner society. Chest 2020;158:106-116 https://doi.org/10.1016/j.chest.2020.04.003
  6. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 2020;295:200463
  7. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020;295:715-721 https://doi.org/10.1148/radiol.2020200370
  8. Yang W, Yan F. Patients with RT-PCR-confirmed COVID-19 and normal chest CT. Radiology 2020;295:E3
  9. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-1069 https://doi.org/10.1001/jama.2020.1585
  10. Oh MD, Park WB, Choe PG, Choi SJ, Kim JI, Chae J, et al. Viral load kinetics of MERS coronavirus infection. N Engl J Med 2016;375:1303-1305 https://doi.org/10.1056/NEJMc1511695
  11. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-513 https://doi.org/10.1016/S0140-6736(20)30211-7
  12. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506 https://doi.org/10.1016/S0140-6736(20)30183-5
  13. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-1720 https://doi.org/10.1056/NEJMoa2002032
  14. Fang X, Zhao M, Li S, Yang L, Wu B. Changes of CT findings in a 2019 novel coronavirus (2019-nCoV) pneumonia patient. QJM 2020;113:271-272 https://doi.org/10.1093/qjmed/hcaa038
  15. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020;80:388-393 https://doi.org/10.1016/j.jinf.2020.02.016
  16. Wei J, Xu H, Xiong J, Shen Q, Fan B, Ye C, et al. 2019 novel coronavirus (COVID-19) pneumonia: serial computed tomography findings. Korean J Radiol 2020;21:501-504 https://doi.org/10.3348/kjr.2020.0112