Prevalence and risk factors for lung involvement on low-dose chest CT (LDCT) in a paucisymptomatic population of 247 patients affected by COVID-19
Authors: Julie Finance
Maxime Castelli
Sebastien Cortaredona
Jean-Yves Gaubert
Alexis Jacquier
Matthieu Million
Michael Dassa
Baptiste Marchi
Axel Bartoli
Philippe Parola
Jean-Christophe Lagier
Paul Habert
Didier Raoult
Arnaud Maurin
Philippe Brouqui
Journal: Insights into Imaging (2020)
Discipline: CLINICAL MEDICINE
Keywords: COVID-19; Pneumonia; Quantitative evaluation; Tomography; X-ray computed.
Affiliations: Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France., UMR 7339, CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale - Centre d'Exploration Métaboliques par Résonance Magnétique), Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, 13385, Marseille, France., IHU-Méditerranée Infection, Marseille, France., IRD, APHM, Aix Marseille Univ, MEPHI, Marseille, France., IRD, APHM, Aix Marseille Univ, VITROME, Marseille, SSA, France., LIIE, Aix Marseille Univ, Marseille, France., CERIMED, Aix Marseille Univ, Marseille, France., Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France. ., LIIE, Aix Marseille Univ, Marseille, France. ., CERIMED, Aix Marseille Univ, Marseille, France. .

Abstract:  Background: Low-dose chest CT (LDCT) showed high sensitivity and ability to quantify lung involvement of COVID-19 pneumopathy. The aim of this study was to describe the prevalence and risk factors for lung involvement in 247 patients with a visual score and assess the prevalence of incidental findings. Methods: For 12 days in March 2020, 250 patients with RT-PCR positive tests and who underwent LDCT were prospectively included. Clinical and imaging findings were recorded. The extent of lung involvement was quantified using a score ranging from 0 to 40. A logistic regression model was used to explore factors associated with a score ≥ 10. Results: A total of 247 patients were analyzed; 138 (54%) showed lung involvement. The mean score was 4.5 ± 6.5, and the mean score for patients with lung involvement was 8.1 ± 6.8 [1-31]. The mean age was 43 ± 15 years, with 121 males (48%) and 17 asymptomatic patients (7%). Multivariate analysis showed that age &gt; 54 years (odds ratio 4.4[2.0-9.6] p &lt; 0.001) and diabetes (4.7[1.0-22.1] p = 0.049) were risk factors for a score ≥ 10. Multivariate analysis including symptoms showed that only age &gt; 54 years (4.1[1.7-10.0] p = 0.002) was a risk factor for a score ≥ 10. Rhinitis (0.3[0.1-0.7] p = 0.005) and anosmia (0.3[0.1-0.9] p = 0.043) were protective against lung involvement. Incidental imaging findings were found in 19% of patients, with a need for follow-up in 0.6%. Conclusion: The prevalence of lung involvement was 54% in a predominantly paucisymptomatic population. Age ≥ 55 years and diabetes were risk factors for significant parenchymal lung involvement. Rhinitis and anosmia were protective against LDCT abnormalities. 

Retracted: No

PubPeer comments:
 Pointed out to me on Twitter. The Methods of the paper state:  This was a single-centre prospective study conducted from the 18th to the 30th of March 2020. Patient enrolment included all consecutive patients presenting to the department of infectious disease for 12 consecutive days with a diagnosis of COVID-19 confirmed by RT-PCR [15] who underwent an unenhanced chest CT with a low- dose protocol (....) The protocol was approved by the local institutional review board. But at the end of the paper, the *Ethics approval and consent to participate* read:  IRB approval was obtained for the study from u201ccomitu00e9 du2019u00e9thique mu00e9ditu00e9ranu00e9e infection 2020 0002 the 01 04 2020u201d. Do I understand correctly that the IRB approval was obtained after the study had been performed? One could interpret the date format either as 1 April 2020 or (US version) January 4 2020. But given the spread of COVID-19 to Europe after 4 January 2020 (first reported case in France was January 24, 2020), the 1 April 2020 interpretation seems the more logical one. Here is the original tweet pointing out this concern: https: twitter.com OSS117_IHU status 1375167539249094661 Of additional concern, the journal replied to that tweet saying they will address this in a Correction. https: twitter.com myESR status 1375435087634923523 In addition, as voiced by Leonid Schneider on Twitter, local institutions cannot approve their own clinical trials. Was approval obtained from the appropriate institution committee? https: twitter.com schneiderleonid status 1375478394956173313 , 
 The article does have a correction, but that was because the Key Point section had been omitted. https: insightsimaging.springeropen.com articles 10.1186 s13244-020-00950-y ,