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AimTo determine if there is a difference in radiological, biochemical, or clinical severity between patients infected with Alpha-variant SARS-CoV-2 compared with those infected with pre-existing strains, and to determine if the computed tomography (CT) severity score (CTSS) for COVID-19 pneumonitis correlates with clinical severity and can prognosticate outcomes.Materials and methodsBlinded CTSS scoring was applied to 137 hospital patients who had undergone both CT pulmonary angiography (CTPA) and whole-genome sequencing of SARS-CoV-2 within 14 days of CTPA between 1/12/20-5/1/21.ResultsThere was no evidence of a difference in imaging severity on CTPA, viral load, clinical parameters of severity, or outcomes between Alpha and preceding variants. CTSS on CTPA strongly correlates with clinical and biochemical severity at the time of CTPA, and with patient outcomes. Classifying CTSS into a binary value of "high" and "low", with a cut-off score of 14, patients with a high score have a significantly increased risk of deterioration, as defined by subsequent admission to critical care or death (multivariate hazard ratio [HR] 2.76, p<0.001), and hospital length of stay (17.4 versus 7.9 days, p<0.0001).ConclusionThere was no evidence of a difference in radiological severity of Alpha variant infection compared with pre-existing strains. High CTSS applied to CTPA is associated with increased risk of COVID-19 severity and poorer clinical outcomes and may be of use particularly in settings where CT is not performed for diagnosis of COVID-19 but rather is used following clinical deterioration.

Original publication

DOI

10.1016/j.crad.2021.11.002

Type

Journal article

Journal

Clinical radiology

Publication Date

02/2022

Volume

77

Pages

148 - 155

Addresses

Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK. Electronic address: maria.tsakok@doctors.org.uk.

Keywords

Modernising Medical Microbiology Group, Humans, Critical Care, Length of Stay, Viral Load, Severity of Illness Index, Retrospective Studies, Cohort Studies, Time Factors, Aged, Middle Aged, Female, Male, United Kingdom, Computed Tomography Angiography, Whole Genome Sequencing, COVID-19, SARS-CoV-2