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Kastamonu Medical Journal

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Original Article
Association of perinephric fat stranding with CT severity scores and mortality in COVID-19 patients
Abstract
Aims: To investigate the relationship between the presence of perinephric fat stranding (PFS) with three consecutive chest CT severity scores (CT-SS), mortality and intensive care unit admission in COVID-19 patients.
Methods: This single-center retrospective study, included 457 (?18 years) COVID-19 patients with positive RT-PCR tests. A radiologist calculated three consecutive CT-SS for COVID-19 pneumonia using a visual scoring system ranging from 0 to 25 points. Grades of PFS on CTs were defined as none, mild, moderate or severe. Firstly, patients were divided into two groups, with and without PFS. The Association of PFS with demographic and laboratory data, CT-SS, and mortality rates were analyzed. We divided patients into four subgroups based on PFS grading and investigated temporal changes of mean CT-SS of three consecutive CTs in each PFS subgroup using a paired-sample test and Wilcoxon signed-rank test.
Results: Patients with PFS were associated with older age (p<0.001) and had higher CT-SS (p=0.03). We found a particularly strong association between PFS and mortality (p<0.001) and intensive care unit admission (p=0.001). Statistical associations were found between PFS and elevated serum BUN (p=0.004), creatinine (p=0.007), CRP (p=0.02), and ferritin (p=0.005). In multivariate logistic regression analysis, older age was associated with 1.067-fold (p<=0.001), PFS 1.964-fold (p=0.007), elevated serum creatinine 3.630-fold (p=0.005) higher risks of mortality. In PFS subgroups other than severe, there were significant increases between the first and second CT-SS (p<0.001, p<0.001, p=0.003).
Conclusion: Perinephric fat stranding is an important CT finding that can alert clinicians to the poor prognosis of COVID-19 patients in early periods.

Keywords : COVID-19, coronavirus, CT, perinephric fat stranding

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1. Behzad S, Aghaghazvini L, Radmard AR, Gholamrezanezhad A.Extrapulmonary manifestations of COVID-19: radiologic and clinicaloverview. Clin Imaging. 2020;66:35-41.
2. Gheblawi M, Wang K, Viveiros A, et al. Angiotensin-converting enzyme2: SARS-CoV-2 receptor and regulator of the renin-angiotensin system:celebrating the 20th anniversary of the discovery of ACE2. Circ Res.2020;126(10):1456-1474.
3. Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ van, van GoorH. Tissue distribution of ACE2 protein, the functional receptor for SARScoronavirus. A first step in understanding SARS pathogenesis. J Pathol A JPathol Soc Gt Britain Irel. 2004;203(2):631-637.
4. Eckerle I, M&uuml;ller MA, Kallies S, Gotthardt DN, Drosten C. In-vitrorenal epithelial cell infection reveals a viral kidney tropism as a potentialmechanism for acute renal failure during Middle East RespiratorySyndrome (MERS) Coronavirus infection. Virol J. 2013;10(1):1-5.
5. Martinez-Rojas MA, Vega-Vega O, Bobadilla NA. Is the kidney a target ofSARS-CoV-2? Am J Physiol Physiol. 2020;318(6):F1454-F1462.
6. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-838.
7. Ronco C, Reis T. Kidney involvement in COVID-19 and rationale forextracorporeal therapies. Nat Rev Nephrol. 2020;16(6):308-310.
8. Su H, Yang M, Wan C, et al. Renal histopathological analysis of 26postmortem findings of patients with COVID-19 in China. Kidney Int.2020;98(1):219-227.
9. Pan X wu, Xu D, Zhang H, Zhou W, Wang L hui, Cui X gang. Identificationof a potential mechanism of acute kidney injury during the COVID-19outbreak: a study based on single-cell transcriptome analysis. IntensiveCare Med. 2020;46(6):1114-1116.
10. Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patientshospitalized with COVID-19. Kidney Int. 2020;98(1):209-218.
11. Heller MT, Haarer KA, Thomas E, Thaete FL. Acute conditions affectingthe perinephric space: imaging anatomy, pathways of disease spread, anddifferential diagnosis. Emerg Radiol. 2012;19(3):245-254.
12. Vanmassenhove J, Van Biesen W, Vanholder R, Lameire N. SubclinicalAKI: ready for primetime in clinical practice? J Nephrol. 2019;32(1):9-16.
13. Huang Q, Li J, Lyu S, et al. COVID-19 associated kidney impairment inadult: Qualitative and quantitative analyses with non-enhanced CT onadmission. Eur J Radiol. 2020;131:109240.
14. Stunell H, Buckley O, Feeney J, Geoghegan T, Browne RFJ, Torreggiani WC.Imaging of acute pyelonephritis in the adult. Eur Radiol. 2007;17(7):1820-1828.
15. Pan F, Ye T, Sun P, Gui S, Liang B, Li L. Time Course of Lung Changes atChest CT during Recovery. Radiology. 2020;295(3):715-721.
16. Takahashi N, Kawashima A, Ernst RD, et al. Ureterolithiasis: canclinical outcome be predicted with unenhanced helical CT? Radiology.1998;208(1):97-102.
17. Farrell MR, Papagiannopoulos D, Ebersole J, White G, Deane LA.Perinephric fat stranding is associated with elevated creatinineamong patients with acutely obstructing ureterolithiasis. J Endourol.2018;32(9):891-895. doi:10.1089/end.2018.0252
18. Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation andclinical classification of coronavirus disease (COVID-19). Eur Radiol.2020;30(8):4407-4416.
19. Huang L, Han R, Ai T, et al. Serial quantitative chest CT assessment ofCOVID-19: a deep learning approach. Radiol Cardiothorac Imaging.2020;2(2):e200075.
20. Lessmann N, S&aacute;nchez CI, Beenen L, et al. Automated assessment ofCOVID-19 reporting and data system and chest CT severity scores inpatients suspected of having COVID-19 using artificial intelligence.Radiology. 2021;298(1):E18-E28.
21. Zhou S, Chen C, Hu Y, Lv W, Ai T, Xia L. Chest CT imaging features andseverity scores as biomarkers for prognostic prediction in patients withCOVID-19. Ann Transl Med. 2020;8(21):1449.
22. Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19patients: correlation with disease severity and short-term prognosis. EurRadiol. 2020;30(12):6808-6817.
23. Kellum JA, van Till JWO, Mulligan G. Targeting acute kidney injury inCOVID-19. Nephrol Dial Transplant. 2020;35(10):1652-1662.
24. Adamczak M, Surma S, Wiecek A. Acute kidney injury in patients withCOVID-19: Epidemiology, pathogenesis and treatment. Adv Clin ExpMed. Published online 2022:317-326.
25. Chan L, Chaudhary K, Saha A, et al. AKI in hospitalized patients withCOVID-19. J Am Soc Nephrol. 2021;32(1):151-160.
26. Fu EL, Janse RJ, de Jong Y, et al. Acute kidney injury and kidney replacementtherapy in COVID-19: a systematic review and meta-analysis. Clin KidneyJ. 2020;13(4):550-563.
27. Robbins-Juarez SY, Qian L, King KL, et al. Outcomes for patients withCOVID-19 and acute kidney injury: a systematic review and meta-analysis. Kidney Int Reports. 2020;5(8):1149-1160.
28. Zhou S, Xu J, Xue C, Yang B, Mao Z, Ong ACM. Coronavirus-associatedkidney outcomes in COVID-19, SARS, and MERS: a meta-analysis andsystematic review. Ren Fail. 2021;43(1):1-15.
29. Kunutsor SK, Laukkanen JA. Renal complications in COVID-19: asystematic review and meta-analysis. Ann Med. 2020;52(7):345-353. doi:10.1080/07853890.2020.1790643
30. Henry BM, Lippi G. Chronic kidney disease is associated with severecoronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol.2020;52(6):1193-1194.
31. Silver SA, Beaubien-Souligny W, Shah PS, et al. The prevalence of acutekidney injury in patients hospitalized with COVID-19 infection: asystematic review and meta-analysis. Kidney Med. 2021;3(1):83-98.
32. Aizenstein RI, Wilbur AC, O&rsquo;NEIL HK. Interfascial and perinephricpathways in the spread of retroperitoneal disease: refined concepts basedon CT observations. Am J Roentgenol. 1997;168(3):639-643.
33. Hiller N, Berkovitz N, Lubashevsky N, Salaima S, Simanovsky N. Therelationship between ureteral stone characteristics and secondary signs inrenal colic. Clin Imaging. 2012;36(6):768-772.
34. Han NY, Sung DJ, Kim MJ, Park BJ, Sim KC, Cho SB. Perirenal fatstranding on CT: is there an association with bladder outlet obstruction?Br J Radiol. 2016;89(1063):20160195.
35. Kim JS, Lee S, Lee KW, Kim JM, Kim YH, Kim ME. Relationship betweenuncommon computed tomography findings and clinical aspects inpatients with acute pyelonephritis. Korean J Urol. 2014;55(7):482-486.
36. Susmitha N, Kapoor A, Narayanan R. Can perinephric fat strandingbe used as a predictor of renal dysfunction in COVID-19 patients? Aretrospective study. J Clin Diagnostic Res. 2022;16:9.
Article available in :
Volume 3, Issue 2, 2023
Page : 89-94
https://doi.org/10.51271/KMJ-0105
Article Information
Received : 28 Nis 2023
Accepted : 26 Haz 2023
Published : 26 Haz 2023
Corresponding Author :

Burcu Akman: Department of Radiology, Faculty of Medicine, Amasya University, Amasya, Turkey

[email protected]
Citation : Akman B, Kaya AT. Association of perinephric fat stranding with CT severity scores and mortality in COVID-19 patients. Kastamonu Med J. 2023;3(2):89-94

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