Clinical importance of thoracal lymphadenopathy in COVID-19

Thoracal lymphadenopathy may predict prognosis in patients with coronavirus disease 2019 (COVID-19), albeit the reported data is inconclusive. The aim of the present analysis was to analyze the affected lymph node stations and the cumulative lymph node size derived from computed tomography (CT) for prediction of 30-day mortality in patients with COVID-19.

The clinical database was retrospectively screened for patients with COVID-19 between 2020 and 2022. Overall, 177 patients (63 female, 35.6%) were included into the analysis. Thoracal lymphadenopathy was defined by short axis diameter above 10 mm. Cumulative lymph node size of the largest lymph nodes was calculated and the amount of affected lymph node stations was quantified.

Overall, 53 patients (29.9%) died within the 30-day observation period. 108 patients (61.0%) were admitted to the ICU and 91 patients needed to be intubated (51.4%). Overall, there were 130 patients with lymphadenopathy (73.4%). The mean number of affected lymph node levels were higher in non-survivors compared to survivors (mean, 4.0 vs 2.2, p < 0.001). The cumulative size was also higher in non-survivors compared to survivors (mean 55.9 mm versus 44.1 mm, p = 0.006). Presence of lymphadenopathy was associated with 30-day mortality in a multivariable analysis, OR = 2.99 (95% CI 1.20 - 7.43), p = 0.02.

Thoracal lymphadenopathy comprising cumulative size and affected levels derived from CT images is associated with 30-day mortality in patients with COVID-19. COVID-19 patients presenting with thoracic lymphadenopathy should be considered as a risk group.