Objectives

To evaluate the diagnostic and prognostic performance of CT in patients referred for COVID19 suspicion to a French university hospital, depending on symptoms and date of onset.

Methods

From March 1st to March 28th, 214 patients having both chest CT scan and reverse transcriptase polymerase chain reaction (RT- PCT) within 24 h were retrospectively evaluated. Sensitivity, specificity, negative and positive predictive values of first and expert readings were calculated together with inter reader agreement, with results of RT-PCR as standard of reference and according to symptoms and onset date. Patient characteristics and disease extent on CT were correlated to short-term outcome (death or intubation at 3 weeks follow-up).

Results

Of the 214 patients (119 men, mean age 59 ± 19 years), 129 had at least one positive RT-PCR result. Sensitivity, specificity, negative and positive predictive values were 79 % (95 % CI: 71–86 %), 84 %(74–91 %), 72 %(63–81 %) and 88 % (81–93 %) for initial CT reading and 81 %(74–88 %), 91 % (82–96 %), 76 % (67–84 %) and 93 % (87–97 %), for expert reading, with strong inter-reader agreement (kappa index: 0.89). Considering the 123 patients with symptoms for more than 5 days, the corresponding figures were 90 %, 78 %, 80 % and 89 % for initial reading and 93 %, 88 %, 86 % and 94 % for the expert. Disease extent exceeded 25 % for 68 % and 26 % of severe and non-severe patients, respectively (p < 0.001).

Conclusion

CT sensitivity increased after 5 days of symptoms. A disease extent > 25 % was associated with poorer outcome.

中文翻译：

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COVID-19肺炎：基于对来自法国巴黎的214位连续患者的回顾性分析，CT的诊断和预后作用。

目标

根据症状和发病日期，评估因COVID19怀疑转诊至法国大学医院的患者中CT的诊断和预后性能。

方法

从3月1日至3月28日，对214例同时在24小时内同时进行胸部CT扫描和逆转录酶聚合酶链反应（RT-PCT）的患者进行了评估。根据阅读者之间的协议，计算第一和专家读数的敏感性，特异性，阴性和阳性预测值，并以RT-PCR的结果作为参考标准并根据症状和发病日期进行计算。CT上的患者特征和疾病程度与短期预后相关（随访3周时死亡或插管）。

结果

在214位患者（119位男性，平均年龄59±19岁）中，有129位患者至少有一项RT-PCR阳性结果。敏感性，特异性，阴性和阳性预测值分别为79％（95％CI：71–86％），84％（74–91％），72％（63–81％）和88％（81–93％）最初的CT读数和81％（74-88％），91％（82-96％），76％（67-84％）和93％（87-97％）的专家阅读，具有较强的阅读者间协议（kappa指数：0.89）。考虑到123名症状持续超过5天的患者，相应的初次阅读率为90％，78％，80％和89％，专家为93％，88％，86％和94％。重度和非重度患者的疾病程度分别超过25％和68％（p <0.001）。

结论

症状出现5天后，CT敏感性增加。疾病程度> 25％与较差的预后相关。