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

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 cohor...

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Published in:European radiology Vol. 31; no. 6; pp. 4031 - 4041
Main Authors: Esposito, Antonio, Palmisano, Anna, Toselli, Marco, Vignale, Davide, Cereda, Alberto, Rancoita, Paola Maria Vittoria, Leone, Riccardo, Nicoletti, Valeria, Gnasso, Chiara, Monello, Alberto, Biagi, Andrea, Turchio, Piergiorgio, Landoni, Giovanni, Gallone, Guglielmo, Monti, Giacomo, Casella, Gianni, Iannopollo, Gianmarco, Nannini, Tommaso, Patelli, Gianluigi, Di Mare, Luisa, Loffi, Marco, Sergio, Pietro, Ippolito, Davide, Sironi, Sandro, Pontone, Gianluca, Andreini, Daniele, Mancini, Elisabetta Maria, Di Serio, Clelia, De Cobelli, Francesco, Ciceri, Fabio, Zangrillo, Alberto, Colombo, Antonio, Tacchetti, Carlo, Giannini, Francesco
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2021
Springer Nature B.V
Subjects:
Aeration
Age
Chest
Computed tomography
Coronaviruses
COVID-19
Creatinine
Derivation
Diagnostic Radiology
Diameters
Enlargement
Evaluation
Hospitals
Hypertension
Imaging
Internal Medicine
Interventional Radiology
Lungs
Males
Medicine
Medicine & Public Health
Model testing
Mortality
Neuroradiology
Patients
Pulmonary arteries
Pulmonary artery
Radiology
Regression analysis
Survival
Ultrasound
Italy
COVID-19
Thorax
Tomography, X-ray computed
Pulmonary artery
Hypertension, pulmonary
ISSN:0938-7994, 1432-1084, 1432-1084
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Summary: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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ISSN:0938-7994
1432-1084
1432-1084
DOI:10.1007/s00330-020-07622-x