Chest computed tomography scan findings of coronavirus disease 2019 (COVID-19) patients: a comprehensive systematic review and meta-analysis

COVID-19 vaccine acceptance among pregnant women worldwide: A systematic review and meta-analysis

Background

The COVID-19 pandemic has led to the death of many people worldwide. The World Health Organization (WHO) has declared vaccine resistance as one of the greatest health threats in the world even before the COVID-19 epidemic. The aim of this study was to evaluate the acceptance of COVID-19 vaccine in pregnant women.

Method

We performed this systematic review and meta-analysis in accordance with the PRISMA guidelines. We applied the standard search strategy to the PubMed/Medline, Web of Science (ISI), Scopus, Science Direct, Cochrane Library, EMBASE, and EBSCO databases, and the Google Scholar search engine. Heterogeneity between studies was relatively high and therefore meta-analyses were performed based on random effects model with 95% CI using STATA version 16.

Results

In 16 articles with a sample size of 19219 pregnant women, the acceptance of COVID-19 vaccine was estimated 53.46% (95%CI: 47.64%-59.24%). Subgroup analysis was performed based on continent (p = 0.796), data collection method (p = 0.450) and meta-regression based on the month of the study (P<0.001), and only meta-regression was significant based on the month of the study. The effect of some variables such as graviad (OR = 1.02 [95%CI: 0.90–1.16]), maternal age was (OR = 1.02 [95%CI: 0.93–1.11]) and history of influenza vaccination (OR = 0.87 [95%CI: 0.71–1.06]) on COVID-19 vaccine acceptance was evaluated, which was not significant.

Conclusion

The prevalence of COVID-19 vaccine acceptance in pregnant women was 53.46%, which was much lower than the general COVID-19 vaccination. Therefore, necessary interventions should be taken to increase the acceptance of the vaccine, address safety concerns and educate about it.

Characteristic patterns of SARS-CoV-2 on chest CT suggests a hematologic pathway for viral entry into the lung

Many SARS-CoV-2 studies have supported the theory that the Type II alveolar epithelial cells (AEC-2) are the primary portal of entry of the virus into the lung following its brief nasal occupation. However, the theory of inhalational transmission of the virus from the ciliated and goblet nasal cells to the lung parenchyma is not supported by the imaging findings on chest computerized tomography (CT), leading the authors to consider an alternative pathway from the nose to the lung parenchyma that could explain the peripheral, basilar predominant pattern of early disease. Imaging supports that the pulmonary capillaries may be an important vehicle for transmission of the virus and/or associated inflammatory mediators to the lung epithelium.

Evaluation of Lactate Dehydrogenase (LDH) in predicting the severity of lung involvement and pneumomediastinum in hospitalized COVID-19

Background

COVID-19 is a health crisis that triggered the need to find a rapid and sensitive tool to screen populations with a high risk of complications. Lactate dehydrogenase (LDH) is an enzyme found in almost all body cells, particularly pneumocytes, and appears to be associated with worst outcome. Pneumomediastinum (PM), which results from ruptured alveoli, can occur in non-ventilated patients. Acute pneumocytes injury induces the release of serum LDH.

Objective

This study evaluates the role of baseline serum LDH levels in predicting COVID-19 lung necrosis.

Methods

This retrospective study was conducted among 524 COVID-19 patients admitted to Hôtel-Dieu de France university hospital, Lebanon, between March 2020 and March 2021. Baseline serum LDH was retrieved from patients’ medical records. Radiological severity outcomes were assessed at admission and during follow-up by non-contrast computed tomography (NCCT) of the chest.

Results

The mean age of participants was 63 ± 16 years, with 359 males (68.5%) and median (IQR) LDH levels upon admission of 328 (248–430). LDH was correlated with lobar involvement at both admission and NCCT follow-up (Spearman’s rho 0.527 and 0.264, respectively) and the development of a PM (p = 0.035) in 3% of the patients. Using ROC analysis, a baseline LDH value higher than 395 U/L was associated with the presence of a PM on admission and follow-up chest CT, with a sensitivity of 75% and a specificity of 60.1%.

Conclusion

Baseline LDH levels could serve as a tool for early diagnosis of severe pulmonary injury with poor radiological outcomes in hospitalized COVID-19 patients.

Virtual autopsy in SARS-CoV-2 breakthrough infection: a case report

It is well documented that COVID-19 vaccines are effective tools for limiting the pandemic. Unfortunately, as is true for all vaccines, SARS-CoV-2 infection in vaccinated individuals is still possible.

We present an autopsy case of SARS-CoV-2 infection after vaccination (“breakthrough infection”) in an elderly man with several comorbidities where post-mortem CT scan was performed. The death was histologically attributed to cardio-respiratory arrest due to ischemic heart failure related to superinfected COVID-19 pneumonia and pre-existing comorbidities. For the first time in the literature, PMCT imaging related to a fatal, autopsy case of breakthrough SARS-CoV-2 infection is reported. PMCT of the lungs, in accordance with histopathological results, showed few signs of COVID-19 pneumonia, large area of consolidation in the right lower lobe, interpreted as bronco-pneumonic focus, and hypostasis.

These findings were well-correlated with the previously reported literature about both PMCT and clinical CT imaging of the lungs in non-vaccinated individuals with early COVID-19 pneumonia and about pulmonary clinical CT imaging in COVID-19 pneumonia in breakthrough SARS-COV-2 infections.

Further studies are needed to cover the whole spectrum of PMCT lung imaging in fatal breakthrough SARS-CoV-2 infection, however, this case represent a first step for exploring this difficult challenge during SARS-CoV-2 pandemic using virtual autopsy.

Analysis of the role of PMCT during the COVID-19 pandemic: a systematic review

Objectives

During COVID-19 pandemic PMCT has been proposed as a forensic investigation method. This systematic review is aimed to systematize evidence and peer-reviewed opinions reported during the first two years of pandemic, to evaluate the role of PMCT during the COVID-19 pandemic.

Materials and methods

An online literature search was performed to identify publications on PMCT during the COVID-19 pandemic between December 2019 and March 2022. For each publication included, the following data were collected: title and abstract, year of publication, type of article, number and type of individuals examined. The selected publications were also categorized based on PMCT findings, histopathological results, the comparison between PMCT and histopathological findings, cause of death and proposed role of PMCT during the pandemic.

Results

A total of 20 publications were included, mostly case reports (9/20). All cases examined included adults. The most frequent PMCT pattern in positive cases was diffuse mixed densities with prevalence of consolidations (pattern 1) (54%). In 97% of the cases where a comparison between PMCT and histological results was performed, a correspondence was found. In 82% of the cases the principal cause of death was COVID-19 pneumonia. PMCT has been proposed as a pre-autopsy screening tool in 62%, and as a method for augmenting post-mortem data in 50% of the papers reporting this issue.

Conclusion

This systematic review suggests that PMCT should be regarded as a highly valuable investigative technique for the forensic evaluation of deaths with ascertained or suspected COVID-19 pneumonia.

Performances of clinical characteristics and radiological findings in identifying COVID-19 from suspected cases

Background

To identify effective factors and establish a model to distinguish COVID-19 patients from suspected cases.

Methods

The clinical characteristics, laboratory results and initial chest CT findings of suspected COVID-19 patients in 3 institutions were retrospectively reviewed. Univariate and multivariate logistic regression were performed to identify significant features. A nomogram was constructed, with calibration validated internally and externally.

Results

239 patients from 2 institutions were enrolled in the primary cohort including 157 COVID-19 and 82 non-COVID-19 patients. 11 features were selected by LASSO selection, and 8 features were found significant using multivariate logistic regression analysis. We found that the COVID-19 group are more likely to have fever (OR 4.22), contact history (OR 284.73), lower WBC count (OR 0.63), left lower lobe involvement (OR 9.42), multifocal lesions (OR 8.98), pleural thickening (OR 5.59), peripheral distribution (OR 0.09), and less mediastinal lymphadenopathy (OR 0.037). The nomogram developed accordingly for clinical practice showed satisfactory internal and external validation.

Conclusions

In conclusion, fever, contact history, decreased WBC count, left lower lobe involvement, pleural thickening, multifocal lesions, peripheral distribution, and absence of mediastinal lymphadenopathy are able to distinguish COVID-19 patients from other suspected patients. The corresponding nomogram is a useful tool in clinical practice.

Potentials of post-mortem CT investigations during SARS-COV-2 pandemic: a narrative review

In December 2019, a new coronavirus, SARS-COV-2, caused a cluster of cases of pneumonia in China, and rapidly spread across the globe. It was declared a pandemic by the World Health Organization on March 11th, 2020. Virtual autopsy by post-mortem CT (PMCT) and its ancillary techniques are currently applied in post-mortem examinations as minimally or non-invasive techniques with promising results. In this narrative review, we speculate on the potentials of PMCT and its ancillary techniques, as a viable investigation technique for analysis of suspected or confirmed SARS-COV-2 deaths. An online literature search was performed by using three prefix search terms (postmortem, post-mortem, post mortem) individually combined with the suffix radiology, imaging, computed tomography, CT and with the search terms ‘SARS-CoV-2’ and ‘COVID-19’ to identify papers about PMCT and its ancillary techniques in SARS-COV-2 positive cadavers. PMCT findings suggestive for pulmonary COVID-19 in deceased positive SARS-COV-2 infection are reported in the literature. PMCT ancillary techniques were never applied in such cases. PMCT imaging of the lungs has been proposed as a pre-autopsy screening method for SARS-COV-2 infection. Further studies are needed to ascertain the value of PMCT in determining COVID-19 as the cause of death without autopsy histopathological confirmation. We advocate the application of PMCT techniques in the study of ascertained or suspected SARS-COV-2 infected deceased individuals as a screening technique and as a method of post-mortem investigation, to augment the numbers of case examined and significantly reducing infection risk for the operators.

Postmortem CT pulmonary findings in SARS-CoV-2-positive cases: correlation with lung histopathological findings and autopsy results

Introduction/purpose

Postmortem computed tomography (PMCT) is a valuable tool for analyzing the death of patients with SARS-CoV-2 infection. The purpose of this study was to investigate the correlation between PMCT lung findings in autopsy cadavers positive for SARS-CoV-2 infection and the severity of COVID-19 lung disease by histopathological analysis.

Materials and methods

We reviewed chest PMCT findings, paying particular attention to the lung parenchyma, in 8 autopsy cases positive for SARS-CoV-2. Correlations between chest PMCT and histopathological findings were assessed. Clinical conditions and comorbidities were also recorded and discussed. The primary cause of death was finally considered.

Results

In 6/8 cases, pulmonary PMCT findings were massive consolidation (4/8) and bilateral diffuse mixed densities with a crazy-paving pattern (2/8). These cases showed severe pulmonary signs of COVID-19 at histopathological analysis. In the remaining 2/8 cases, pulmonary PMCT findings were scant antideclive ground-glass opacities in prevalent gradient densities attributed to hypostasis. In 4/8 cases with massive consolidations, important comorbidities were noted. In 6/8 cases with severe pulmonary histopathological signs of lung COVID-19, autopsy found that the cause of death was cardiorespiratory failure. In the remaining 2/8 cases, histopathological analysis revealed lung alterations due to edema and some signs of SARS-CoV-2 infection; the cause of death was not attributed to SARS-CoV-2 infection (Table 1).

Discussion and conclusion

Chest PMCT findings correlate with the severity of COVID-19 lung disease at histopathology examination. According to our results, there may also be a relationship between cause of death and PMCT findings in COVID-19, which must be critically analyzed considering clinical antemortem data.

Chest imaging findings in COVID-19-positive patients in an Australian tertiary hospital

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has infected over 215 million individuals worldwide. Chest radiographs (CXR) and computed tomography (CT) have assisted with diagnosis and assessment of COVID-19. Previous reports have described peripheral and lower zone predominant opacities on chest radiographs. Whilst the most common patterns on CT are bilateral, peripheral basal predominant ground glass opacities (Wong et al., Radiology, 296, 2020, E72; Karimian and Azami, Pol J Radiol, 86, 2021, e31). This study describes the imaging findings in an Australian tertiary hospital population.

METHODS

COVID-PCR-positive patients who had chest imaging (CXR, CT and ventilation perfusion (V/Q) scans) from January 2020 to August 2020 were included. Distribution, location and pattern of involvement was recorded. Evaluation of the assessors was performed using Fleiss Kappa calculations for review of radiographic findings and qualitative analysis of CT findings.

RESULTS

A total of 681 studies (616 CXRs, 59 CTs, 6 V/Q) from 181 patients were reviewed. The most common chest radiograph finding was bilateral lower lobe predominant diffuse opacification and most common CT pattern being ground glass opacities. Of the CT imaging, 33 were CT Pulmonary Angiograms of which five demonstrated acute pulmonary emboli. There was good inter-rater agreement between radiologists in assessment of imaging appearances on CXR (kappa 0.29-0.73) and CT studies.

CONCLUSION

A review of imaging in an Australian tertiary hospital demonstrates similar patterns of COVID-19 infection on chest X-ray and CT imaging when compared to the international population.