Chest CT scan predictors of intensive care unit admission in hospitalized pregnant women with COVID-19: a case–control study

To investigate the role of chest computed tomography (CT) scan in the prediction of admission of pregnant women with COVID-19 into intensive care unit (ICU).
This was a single-center retrospective case–control study. We included pregnant women diagnosed with COVID-19 by reverse transcriptase polymerase chain reaction between February 2020 and July 2021, requiring hospital admission due to symptoms, who also had a CT chest scan at presentation. Patients admitted to the ICU (case group) were compared with patients who did not require ICU admission (control group). The CT scans were reported by an experienced radiologist, blinded to the patient’s course and outcome, aided by an artificial intelligence software. Total CT scan score, chest CT severity score (CT-SS), total lung volume (TLV), infected lung volume (ILV), and infected-to-total lung volume ratio (ILV/TLV) were calculated. Receiver operating characteristic curves were constructed to test the sensitivity and specificity of each parameter.
8/28 patients (28.6%) required ICU admission. These also had lower TLV, higher ILV, and ILV/TLV. The area under the curve (AUC) for these three parameters was 0.789, 0.775, and 0.763, respectively. TLV, ILV, and ILV/TLV had good sensitivity (62.5%, 87.5%, and 87.5%, respectively) and specificity (84.2%, 70%, and 73.7%, respectively) for predicting ICU admission at the following selected thresholds: 2255 mL, 319 mL, and 14%, respectively. The performance of CT-SS, CT scan score, and ILV/TLV in predicting ICU admission was comparable.
TLV, ILV, and ILV/TLV as measured by an artificial intelligence software on chest CT, may predict ICU admission in hospitalized pregnant women, symptomatic for COVID-19.

本研究旨在探讨胸部计算机断层扫描（computed tomography, CT）在预测新型冠状病毒肺炎（COVID-19）孕妇收治重症监护病房（intensive care unit, ICU）中的作用。
本研究为单中心回顾性病例对照研究。研究纳入2020年2月至2021年7月期间，经逆转录聚合酶链反应（reverse transcriptase polymerase chain reaction）确诊为COVID-19、因症状需住院治疗且就诊时行胸部CT扫描的孕妇。将收治至ICU的患者（病例组）与无需ICU收治的患者（对照组）进行比较。所有胸部CT扫描均由一名对患者病程及转归不知情的资深放射科医师借助人工智能软件进行阅片报告，并计算了总CT扫描评分、胸部CT严重程度评分（CT-SS）、肺总容积（TLV）、感染肺容积（ILV）以及感染肺容积与肺总容积之比（ILV/TLV）。绘制受试者工作特征曲线，以检验各参数的敏感度与特异度。
28例患者中8例（28.6%）需收入ICU。该部分患者的肺总容积更低，感染肺容积及感染肺容积与肺总容积之比更高。
这三项参数的曲线下面积（AUC）分别为0.789、0.775和0.763。
在选定的截断值（分别为2255 mL、319 mL及14%）下，肺总容积、感染肺容积及感染肺容积与肺总容积之比预测ICU收治的敏感度分别为62.5%、87.5%及87.5%，特异度分别为84.2%、70%及73.7%，表现良好。
胸部CT严重程度评分、总CT扫描评分与感染肺容积与肺总容积之比在预测ICU收治方面的表现相当。
通过人工智能软件对胸部CT进行测量得到的肺总容积、感染肺容积及感染肺容积与肺总容积之比，或可预测有症状的COVID-19住院孕妇的ICU收治风险。