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Factors Associated with Worsening Oxygenation in Patients with Non-severe COVID-19 Pneumonia

Tuberculosis and Respiratory Diseases 2021년 84권 2호 p.115 ~ 124
함초롬, 이영경, 오동현, 안미영, 최재필, 강나리, 오정균, Choi Han-Zo, 김수현,
소속 상세정보
함초롬 ( Hahm Cho-Rom ) - Seoul Medical Center Department of Internal Medicine
이영경 ( Lee Young-Kyung ) - Seoul Medical Center Department of Radiology
오동현 ( Oh Dong-Hyun ) - Seoul Medical Center Department of Internal Medicine
안미영 ( Ahn Mi-Young ) - Seoul Medical Center Department of Internal Medicine
최재필 ( Choi Jae-Phil ) - Seoul Medical Center Department of Internal Medicine
강나리 ( Kang Na-Ree ) - Seoul Medical Center Department of Internal Medicine
오정균 ( Oh Jung-Kyun ) - Seoul Medical Center Department of Hospital Medicine
 ( Choi Han-Zo ) - Myongji St. Mary’s Hospital Department of Emergency Medicine
김수현 ( Kim Su-Hyun ) - Seoul Medical Center Department of Internal Medicine

Abstract


Background: This study aimed to determine the parameters for worsening oxygenation in non-severe coronavirus disease 2019 (COVID-19) pneumonia.

Methods: This retrospective cohort study included cases of confirmed COVID-19 pneumonia in a public hospital in South Korea. The worsening oxygenation group was defined as that with SpO2 ≤94% or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the non-worsening oxygenation group that did not experience any respiratory event. Parameters were compared, and the extent of viral pneumonia from an initial chest computed tomography (CT) was calculated using artificial intelligence (AI) and measured visually by a radiologist.

Results: We included 136 patients, with 32 (23.5%) patients in the worsening oxygenation group; of whom, two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups; however, univariate logistic regression analysis revealed that a variety of parameters on admission were associated with an increased risk of a desaturation event. A subset of patients was studied to eliminate potential bias, that ferritin ≥280 μg/L (p=0.029), lactate dehydrogenase ≥240 U/L (p=0.029), pneumonia volume (p=0.021), and extent (p=0.030) by AI, and visual severity scores (p=0.042) were the predictive parameters for worsening oxygenation in a sex-, age-, and comorbid illness-matched case-control study using propensity score (n=52).

Conclusion: Our study suggests that initial CT evaluated by AI or visual severity scoring as well as serum markers of inflammation on admission are significantly associated with worsening oxygenation in this COVID-19 pneumonia cohort.

키워드

Pneumonia; COVID-19; Computed Tomography; Artificial Intelligence; Oxygenation

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