COVID-19 Chest CT Quantification: Triage and Prognostic Value in Different Ages

Area of Science:

• Radiology
• Medical Imaging
• Pulmonology

Background:

• The COVID-19 pandemic necessitated rapid assessment and prognostication of patients.
• Computed tomography (CT) severity scores (CTSS) were proposed to aid in evaluating disease severity.
• The performance of these CTSS systems across different age groups remained unclear.

Purpose of the Study:

• To evaluate the triage and prognostic performance of seven CTSS systems.
• To compare CTSS performance in two distinct age groups: ≥65 years and ≤64 years.
• To identify CTSS with the best inter-rater reliability.

Main Methods:

• Retrospective analysis of 96 COVID-19 positive patients.
• Patients categorized into age groups: ≥65 years (n=55) and ≤64 years (n=41).
• Seven CTSS were applied to initial CT images; triage and prognostic performance assessed using ROC analysis.

Main Results:

• All CTSS demonstrated minimal triage value in the overall cohort (AUC < 0.700, except CTSS2).
• Prognostic performance was acceptable across all CTSS in the overall cohort (AUC 0.759–0.781).
• In patients ≥65 years, CTSS showed excellent triage (AUC 0.796–0.830) and prognostic (AUC 0.859–0.919) performance. In patients ≤64 years, CTSS showed unsatisfactory triage (AUC 0.487–0.565) and prognostic (AUC 0.668–0.694) performance, except CTSS6 for prognostication (AUC 0.700).
• CTSS2, CTSS5, and CTSS7 exhibited the highest inter-rater reliability (ICC).

Conclusions:

• CTSS have limited value for triage but acceptable prognostic capability in COVID-19 patients.
• CTSS performance is age-dependent, being excellent in older adults (≥65 years) and poor in younger adults (≤64 years).
• CTSS2, CTSS5, and CTSS7 are recommended when high inter-rater reliability is crucial.