Evaluation of the chest computed tomography and hemogram data in patients with COVID-19: the importance of thymus
Evaluation of the chest computed tomography and hemogram data in patients with COVID-19: the importance of thymus
Background/aim: To investigate the relationship between imaging findings and peripheral blood cell counts of COVID-19 patients and the degree of thymus fat involution of these patients. Materials and methods: Computed tomography (CT) images of 87 patients with COVID-19 positive through RT-PCR testing were evaluated retrospectively by two radiologists. Ground glass densities and other signs of viral pneumonia were recorded, lung involvement was scored quantitatively. The patients thymus fat involution was graded on CT. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratios (PLR), lymphocyte and platelet counts were calculated. Imaging findings and degrees of thymus fat involution were compared with laboratory data. Results: Quantitative scoring of lung involvement was calculated at mean 6.63 ± 4.70 (1–23) for observer 1 and mean 6.55 ± 4.65 (1–23) for observer 2 (K = 0.824–1.000). Statistical significance was determined between the increase in age and the increase in scores of lung findings (p = 0.003). Lymphocyte count (p = 0.0001) and PLR (p = 0.001) were significantly lower in patients with severe CT involvement. A statistically significantcorrelation was found between increased thymus fat component and presence of COVID-19 lung involvement in CT (r = 0.461). Conclusion: The severity of imaging findings for COVID-19 patients significantly correlates with the degree of fat involution in patients’ thymus tissue.Key words: COVID-19, pneumonia, chest, thymus, lymphocyte, platelet
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- 1. Zhu N, Zhang D, Wang W, Li X, Yang B et al. A novel coronavirus from patients with pneumonia in China, 2019. The New England Journal of Medicine 2020; 382 (8): 727-733. doi: 10.1056/NEJMoa2001017
- 2. Azhar EI, Hui DSC, Memish ZA, Drosten C, Zumla A. The Middle East Respiratory Syndrome (MERS). Infectious Disease Clinics of North America 2019; 33 (4): 891-905. doi: 10.1016/j. idc.2019.08.001
- 3. Chen N, Zhou M, Dong X, Qu J, Gong F et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513. doi: 10.1016/S0140-6736(20)30211-7
- 4. Pan Y, Guan H, Zhou S, Wang Y, Li Q et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. European Radiology 2020; 30 (6): 3306-3309. doi: 10.1007/s00330-020-06731-x
- 5. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): asystematic review of imaging findings in 919 patients. American Journal of Roentgenology 2020; 215 (1): 87-93. doi: 10.2214/AJR.20.23034
- 6. Zhou S, Wang Y, Zhu T, Xia L. CT features of coronavirus disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China. American Journal of Roentgenology 2020; 214 (6): 1287-1294. doi: 10.2214/AJR.20.22975
- 7. Çinkooğlu A, Bayraktaroğlu S, Savaş R. Lung changes on chest CT during 2019 novel coronavirus (COVID-19) pneumonia. European Journal of Breast Health 2020; 16 (2): 89-90. doi: 10.5152/ejbh.2020.010420
- 8. Caruso D, Zerunian M, Polici M, Pucciarelli F, Polidori T et al. Chest CT Features of COVID-19 in Rome, Italy. Radiology 2020; 296 (2): 79-85. doi: 10.1148/radiol.2020201237
- 9. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): a metaanalysis. Journal of Medical Virology 2020; 92 (10): 1733- 1734. doi: 10.1002/jmv.25819
- 10. Liu Y, Du X, Chen J, Jin Y, Peng L et al. Neutrophil-tolymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. The Journal of Infection 2020; 81 (1): 6-12. doi: 10.1016/j.jinf.2020.04.002
- 11. Qu R, Ling Y, Zhang YH, Wei LY, Chen X et al. Platelet-tolymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. Journal of Medical Virology 2020; 92 (9): 1533-1541. doi: 10.1002/jmv.25767
- 12. Ackman JB, Kovacina B, Carter BW, Wu CC, Sharma A et al. Sex difference in normal thymic appearance in adults 20-30 years of age. Radiology 2013; 268 (1): 245-253. doi: 10.1148/ radiol.13121104
- 13. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246 (3): 697-722. doi: 10.1148/ radiol.2462070712
- 14. Wang Y, Dong C, Hu Y, Li C, Ren Q et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study. Radiology 2020; 296 (2): 55-64. doi: 10.1148/radiol.2020200843
- 15. Ooi GC, Khong PL, Muller NL, Yiu WC, Zhou LJ et al. Severe acute respiratory syndrome: temporal lung changes at thinsection CT in 30 patients. Radiology 2004; 230 (3): 836-844. doi: 10.1148/radiol.2303030853
- 16. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. The Journal of Infection 2020; 80 (6): 14-18. doi: 10.1016/j.jinf.2020.03.005
- 17. Lin C, Ding Y, Xie B, Sun Z, Li X et al. Asymptomatic novel coronavirus pneumonia patient outside Wuhan: the value of CT images in the course of the disease. Clinical Imaging 2020; 63: 7-9. doi: 10.1016/j.clinimag.2020.02.008
- 18. Huang C, Wang Y, Li X, Ren L, Zhao J et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506. doi: 10.1016/S0140- 6736(20)30183-5
- 19. Qin C, Zhou L, Hu Z, Zhang S, Yang S et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical infectious diseases: an Official Publication of the Infectious Diseases Society of America 2020; 71 (15): 762- 768. doi: 10.1093/cid/ciaa248
- 20. Wang D, Hu B, Hu C, Zhu F, Liu X et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirusinfected pneumonia in Wuhan, China. Journal of The American Medical Association 2020; 323 (11): 1061-1069. doi: 10.1001/jama.2020.1585
- 21. Wang F, Nie J, Wang H, Zhao Q, Xiong Y et al. Characteristics of peripheral lymphocyte subset alteration in COVID-19 pneumonia. The Journal of Infectious Diseases 2020; 221 (11): 1762-1769. doi: 10.1093/infdis/jiaa150
- 22. Xu Z, Shi L, Wang Y, Zhang J, Huang L et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet Respiratory Medicine 2020; 8 (4): 420-422. doi: 10.1016/S2213-2600(20)30076-X
- 23. Chung M, Bernheim A, Mei X, Zhang N, Huang M et al. CT imaging features of 2019 novel coronavirus (2019- nCoV). Radiology 2020; 295 (1): 202-207. doi: 10.1148/ radiol.2020200230