Risk Factors and Computed Tomography Findings in COVID-19.
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|ClinicalTrials.gov Identifier: NCT04577105|
Recruitment Status : Completed
First Posted : October 6, 2020
Last Update Posted : October 8, 2020
In the SARS-CoV2 pandemic, imaging studies proved its diagnostic utility to determine the severity of lung involvement. Computed tomography (CT) is a state-of-the-art study proven to be a highly sensitive diagnostic test complemented by RT-PCR testing to determine the disease and the degree of severity.
In March 2020, the Dutch Society of Radiology developed a standardized assessment scheme for COVID-19 lung disease, called CO-RADS. This system proposes a level of suspicion of pulmonary involvement of COVID-19, based on the simple chest tomography findings. The level of suspicion ranges from very low (CO-RADS 1) to very high (CO-RADS 5), with two additional categories involving a technically deficient study (CO-RADS 0) and a positive RT-PCR test for SARS -CoV-2 known before tomography (CO-RADS 6).
For its part, acute respiratory damage secondary to SARS-COV2 pneumonia causes acute respiratory distress syndrome, which warrants immediate medical attention. During the evaluation and triage of patients with suspected or confirmed SARS-COV2 infection, it is a challenge for health personnel given that the severity and clinical presentation is highly variable. The patient's risk stratification is carried out using previously established and validated risk scales and is a fundamental tool for making clinical decisions. Some of the risk indices and scales have been developed and used in the pandemic epicenters, such as China and Europe. Useful for the clinician is the national early warning scale (NEWS 2), severe disease risk assessment score (COVID-GRAM), the rapid severity index for COVID-19 (qCSI), evaluation score of Modified sequential organ failure (mSOFA), the sepsis-induced coagulopathy score (SIC), the ROX index as a predictor of success to the high-flow nasal cannula. The evaluation of the risk of thrombotic complications such as the Padua risk, of cardiac complications such as QT segment prolongation, through the Tisdale risk score.
Risk stratification is essential in the current COVID-19 pandemic situation; upon admission, the clinician will discern if the patient requires in-hospital medical treatment, the risk of severe disease, and progression to assisted mechanical ventilation.
This work aims to establish whether the severity of the findings identified by cardiac tomography upon admission and the risk established by the different established prognostic indices.
|Condition or disease||Intervention/treatment|
|Covid19 ARDS Pneumonia, Viral Computed Tomography||Diagnostic Test: Simple chest tomography|
|Study Type :||Observational|
|Actual Enrollment :||233 participants|
|Official Title:||Risk Factors, Prognosis and Findings by Computed Tomography in Patients Infected by COVID-19 and Its Association With Severity.|
|Actual Study Start Date :||April 1, 2020|
|Actual Primary Completion Date :||August 31, 2020|
|Actual Study Completion Date :||October 1, 2020|
Suspected, probable, or confirmed COVID-19 case
Patients who come to the emergency room with symptoms compatible with a suspected, probable, or confirmed case of SARS-CoV2 infection, in which a chest computed tomography (CT) scan was requested for suspected COVID-19 pneumonia, will be evaluated. On April 1 and August 28, 2020.
Diagnostic Test: Simple chest tomography
The images were acquired with a Siemens 256-slice multidetector tomograph (SOMATOM DEFINITION FLASH 128x2) following the recommended parameters for low-dose simple chest tomography. The chest topogram was acquired using 35 mA, 100 Kv, and 6 mm slices, then the chest tomographic slices holding inspiration in a cephalocaudal direction with 80 mA, 100 Kv, a duration of 2.24 seconds, a pitch of 1, and slices 1 mm with a total of 110 DLP, which is calculated with the conversion factor for thorax a total of 1.5 mSv. Multiplanar reconstructions with Kernel filters B26f, B50f, and B70 for mediastinum and lung, respectively, at 1 mm slices.
Other Name: CT
- Assessment of the level of suspicion of SARS-CoV2 infection [ Time Frame: At hospital admission ]CO-RADS will categorize the level of suspicion of COVID-19. Very low (CO-RADS 1) to very high (CO-RADS 5), with two additional categories involving a technically deficient study (CO-RADS 0) and a positive RT-PCR test for SARS-CoV- 2 known before tomography (CO-RADS 6).
- Evaluate the severity degree of pulmonary affection by chest computed tomography [ Time Frame: At hospital admission ]It will be a semi-quantitative assessment of lung lobe lesions' extent considering five lobes (upper right lobes, middle lobe, lower right lobe, upper left lobe, and lower left lobe). Each of these lobes, depending on their condition, is scored from 1 to 5, with 1 <5%, 2 from 5 to 25%, 3> 25 to 50%, 4 from> 50 to 75% and the number 5 greater than 75%. With this, it is grouped into mild affection from 1 to 5 points, moderate from 5 to 15 points, and greater than 15 points as severe affection
- Percentage of patients requiring endotracheal intubation [ Time Frame: From admission to discharge, up to 1 week ]The requirement for orotracheal intubation and the start of assisted mechanical ventilation after admission will be evaluated
- Death from any cause [ Time Frame: From admission to discharge, up to 1 week ]Patients who present fatal descent during hospitalization will be evaluated.
- Modified Sequential Organ Failure Assessment (mSOFA) [ Time Frame: At hospital admission ]The evaluation of multiple organ failure secondary to sepsis will be carried out using the mSOFA scale, which can predict in-hospital mortality and 30 days, with a minimum score of 0-7 that translates mortality of 0% and a score greater than 11 translates mortality of 58%.
- Sepsis-induced coagulopathy (SIC) [ Time Frame: At hospital admission ]The sepsis-induced coagulopathy score scale (SIC) refers to the diagnosis of coagulopathy when the score is greater than 4 or the INR is greater than or equal to 3.
- National Early Warning Scale (NEWS 2) [ Time Frame: At hospital admission ]A score of 0-4 confers a low risk; on the contrary, a score of more than 7 gives a high risk.
- COVID-GRAM severe illness risk score [ Time Frame: At hospital admission ]It establishes three risk groups: the mild one with a risk of critical illness of less than 1.7% and the high risk of more than 40.4%.
- Rapid Severity Index for COVID-19 (qCSI) [ Time Frame: At hospital admission ]A score less than or equal to 3 gives a low risk with a critical illness risk of 4%, while a score of 10-12 gives a high risk and a critical illness probability of 57%.
- Neutrophil-Lymphocyte Ratio (NLR) [ Time Frame: At hospital admission ]A ratio of 6-8 translates mild physiological stress, while a ratio of more than 18 a severe physiological stress level.
- Alveolar-arterial gradient of oxygen [ Time Frame: At hospital admission ]The gradient Aa O2 = [(FiO2) × (Atmospheric pressure - Pressure of H2O) - (PaCO2 / 0.8)] - PaO2 of ABG is calculated and a normal gradient with age is estimated with the following formula: Estimate of normal gradient = (Age / 4) + 4. The gradient is increased in conditions such as ARDS, PE, and cardiac failure.
- Berlin Criteria for Acute Respiratory Distress Syndrome [ Time Frame: At hospital admission ]
Required criteria (must have all three of the following): Timing within 1 week of clinical insult or new/worsening respiratory symptoms, Chest XR shows bilateral opacities not fully explained by effusions, lobar/lung collapse, or nodules Respiratory failure not fully explained by cardiac failure/fluid overload Risk factor (one of the following): Risk factor for ARDS present (e.g. pneumonia, trauma, sepsis, pancreatitis).
Objective assessment (Echo) excludes hydrostatic edema.
Severity (based on oxygenation, select one of the following): Mild: PaO₂/FiO₂ >200 to ≤300 mmHg with PEEP OR CPAP ≥5 cm H₂O, Moderate: PaO₂/FiO₂ >100 to ≤200 mmHg with PEEP ≥5 cm H₂O and Severe: PaO₂/FiO₂ ≤100 mmHg with PEEP ≥5 cm H₂O
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Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04577105
|Instituto Nacional Ignacio Chavez|
|Ciudad de mexico, Mexico, 14080|
|Principal Investigator:||Sergio Andres Criales Vera, MD||Insituto Nacional de Cardiologia Ignacio Chavez|