Background: SARS-CoV-2 (COVID-19) pandemic continues to remain a global crisis with the emergence of new virulent variants, including the recent spikes in the cases of delta variant. While RT-PCR is the diagnostic test of choice, High-Resolution Computed Tomography (HRCT) chest has been utilized to assess disease severity. We aim to study the association between bilateral multiple lobular lung involvement on admission chest CT scans, and outcomes in COVID-19 hospitalized patients in this meta-analysis.
Methods: We identified English full-text-observational studies with data on COVID-19 hospitalizations, CT scan findings on admissions, and composite outcomes searching PubMed, Web of Science, and Scopus using the combination of MeSH terms and keywords “COVID-19”, “coronavirus”, “SARS-CoV-2”, “2019-nCoV”, and “lung involvement” and “chest CT scan” between the period from January 1, 2020 to December 30, 2020 utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Composite poor outcomes were defined by ICU admission, oxygen saturation (SpO2) <90%, invasive mechanical ventilation (IMV) utilization, severe disease, and in-hospital mortality. Bilateral lobular involvement of CT scans was characterized by ground-glass opacities (GGO), consolidation, crazy-paving pattern, air bronchogram, linear opacities, bronchial wall thickening, and pleural effusion. The pooled prevalence of bilateral multiple lobular involvements on admission chest CT scans amongst poor composite outcomes and non-poor outcomes subjects was calculated. Meta-analysis with a random-effects model was performed to calculate odds ratio (OR) and 95% confidence interval (95% CI) for evaluating the effects of bilateral multiple lobular involvements on composite outcomes of COVID-19 hospitalizations. Heterogeneity (I2) >50% and p<0.05 were considered of statistical significance.
Results: Twelve studies with 3485 confirmed COVID-19 patients were included. The pooled prevalence of bilateral multiple lobular involvements on admission chest CT scans was higher amongst patients with poor composite outcomes [75.95% (420/553)], in comparison with non-poor outcomes [60.95% (1787/2932)] (p<0.00001). In our study, COVID-19 hospitalizations with on-admission bilateral multiple lobular involvement had 2.54-fold (95% CI: 1.81-3.38; p<0.00001) higher odds of having poor composite outcomes (I2=37%; p=0.09).
Conclusions: Our meta-analysis demonstrates a statistical association between bilateral multiple lobular lung involvement on admission chest CT scans and poor outcomes amongst COVID-19 hospitalizations. To better understand this association further and manage patients proactively, prospective cohort studies are needed.
