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Open Access 01-06-2021 | Pulmonary Hypertension | Chest

Chest CT–derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy

Authors: Antonio Esposito, Anna Palmisano, Marco Toselli, Davide Vignale, Alberto Cereda, Paola Maria Vittoria Rancoita, Riccardo Leone, Valeria Nicoletti, Chiara Gnasso, Alberto Monello, Andrea Biagi, Piergiorgio Turchio, Giovanni Landoni, Guglielmo Gallone, Giacomo Monti, Gianni Casella, Gianmarco Iannopollo, Tommaso Nannini, Gianluigi Patelli, Luisa Di Mare, Marco Loffi, Pietro Sergio, Davide Ippolito, Sandro Sironi, Gianluca Pontone, Daniele Andreini, Elisabetta Maria Mancini, Clelia Di Serio, Francesco De Cobelli, Fabio Ciceri, Alberto Zangrillo, Antonio Colombo, Carlo Tacchetti, Francesco Giannini

Published in: European Radiology | Issue 6/2021

Abstract

Objectives

Enlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients.

Methods

This is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox’s regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort.

Results

In the derivation cohort, the median age was 69 (IQR, 58–77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59–77) years with 421 (66.5%) males. Enlarged MPAD (≥ 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253–2.418], p < 0.001) and multivariable regression analysis (HR [95%CI]: 1.592 [1.154–2.196], p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796–0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758–0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825]).

Conclusion

Enlarged MPAD (≥ 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19.

Key Points

• Enlargement of main pulmonary artery diameter at chest CT performed within 72 h from the admission was associated with a higher rate of in-hospital mortality in COVID-19 patients.

• Enlargement of main pulmonary artery diameter (≥ 31 mm) was an independent predictor of death in COVID-19 patients at adjusted and multivariable regression analysis.

• The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients.

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Title: Chest CT–derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy
Authors: Antonio Esposito
Anna Palmisano
Marco Toselli
Davide Vignale
Alberto Cereda
Paola Maria Vittoria Rancoita
Riccardo Leone
Valeria Nicoletti
Chiara Gnasso
Alberto Monello
Andrea Biagi
Piergiorgio Turchio
Giovanni Landoni
Guglielmo Gallone
Giacomo Monti
Gianni Casella
Gianmarco Iannopollo
Tommaso Nannini
Gianluigi Patelli
Luisa Di Mare
Marco Loffi
Pietro Sergio
Davide Ippolito
Sandro Sironi
Gianluca Pontone
Daniele Andreini
Elisabetta Maria Mancini
Clelia Di Serio
Francesco De Cobelli
Fabio Ciceri
Alberto Zangrillo
Antonio Colombo
Carlo Tacchetti
Francesco Giannini
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keywords: Pulmonary Hypertension
Pneumonia
COVID-19
Pulmonary Hypertension
Hypertension
Pulmonary Hypertension
Pulmonary Hypertension
Hypertension
Published in: European Radiology / Issue 6/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07622-x

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Chest CT–derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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