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Background
CT-scan and inflammatory and coagulation biomarkers could help in prognostication of COVID-19 in patients on ICU admission.
Objective
The objectives of this study were to measure the prognostic value of the extent of lung parenchymal lesions on computed tomography (CT) and of several coagulation and inflammatory biomarkers, and to explore the characteristics of the patients depending on the extent of lung parenchymal lesions.
Design
Retrospective monocentric observational study achieved on a dataset collected prospectively.
Setting
Medical ICU of the university hospital of Clermont-Ferrand, France.
Patients
All consecutive adult patients aged ≥18 years admitted between 20 March, 2020 and 31 August, 2021 for COVID-19 pneumonia.
Interventions
Characteristics at baseline and during ICU stay, and outcomes at day 60 were recorded. The extent of lung parenchyma lesions observed on the chest CT performed on admission was established by artificial intelligence software.
Measurements
Several clinical characteristics and laboratory features were collected on admission including plasma interleukin-6, HLA-DR monocytic–expression rate (mHLA-DR), and the extent of lung parenchymal lesions. Factors associated with day-60 mortality were investigated by uni- and multivariate survival analyses.
Results
270 patients were included. Inflammation biomarkers including the levels of neutrophils, CRP, ferritin and Il10 were the indices the most associated with the severity of the extent of the lung lesions. Patients with more extensive lung parenchymal lesions (≥ 75%) on admission had higher CRP serum levels. The extent of lung parenchymal lesions was associated with a decrease in the PaO2/FiO2 ratio(p<0.01), fewer ventilatory-free days (p = 0.03), and a higher death rate at day 60(p = 0.01). Extent of the lesion of more than 75% was independently associated with day-60 mortality (aHR = 1.72[1.06; 2.78], p = 0.03). The prediction of death at day 60 was improved when considering simultaneously biological and radiological markers obtained on ICU admission (AUC = 0.78).
Conclusions
The extent of lung parenchyma lesions on CT was associated with inflammation, and the combination of coagulation and inflammatory biomarkers and the extent of the lesions predicted the poorest outcomes.

背景：计算机断层扫描（CT）联合炎症与凝血生物标志物，可辅助ICU收治的新型冠状病毒肺炎（COVID-19）患者的预后判断。
研究目的：本研究旨在评估计算机断层扫描（CT）所示肺实质病变范围以及多项凝血、炎症生物标志物的预后价值，并基于肺实质病变范围探究患者的临床特征。
研究设计：本研究为回顾性单中心观察性研究，数据来源于前瞻性收集的数据集。
研究场景：法国克莱蒙费朗大学附属医院医疗重症监护病房。
研究对象：2020年3月20日至2021年8月31日期间，因新型冠状病毒肺炎（COVID-19）入院的所有连续入选的成年患者（年龄≥18岁）。
数据收集：记录患者基线及ICU住院期间的临床特征，以及入院60天时的转归结局；入院时胸部CT所示的肺实质病变范围，由人工智能软件进行量化评估。
观测指标：收集患者入院时的多项临床特征与实验室检测指标，包括血浆白细胞介素-6（IL-6）、单核细胞人类白细胞抗原-DR表达率（mHLA-DR）以及肺实质病变范围；采用单因素与多因素生存分析，探究与入院60天死亡率相关的影响因素。
研究结果：本研究共纳入270例患者。包括中性粒细胞、C反应蛋白（CRP）、铁蛋白及白细胞介素-10（IL-10）水平在内的炎症生物标志物，与肺病变范围的严重程度关联最为显著。入院时肺实质病变范围≥75%的患者，其血清CRP水平更高。肺实质病变范围与动脉血氧分压/吸入氧分数（PaO₂/FiO₂）比值降低（p<0.01）、无通气天数减少（p=0.03）以及入院60天死亡率升高（p=0.01）显著相关。病变范围>75%是入院60天死亡率的独立影响因素（调整后风险比[aHR]=1.72[95%置信区间：1.06~2.78]，p=0.03）。同时纳入ICU入院时获取的生物学与影像学标志物时，入院60天死亡预测效能得到提升（受试者工作特征曲线下面积[AUC]=0.78）。
研究结论：CT所示肺实质病变范围与炎症状态密切相关；联合凝血、炎症生物标志物及肺实质病变范围，可有效预测不良临床结局。