Contribution of imaging in Covid-19 pneumonia management in Rwanda: computed tomography (Ct) versus clinical presentation

Abstract

Background: Over 5.54 million COVID-19 deaths occurred worldwide by January 2021. In Rwanda, 125,000 COVID-19 cases were confirmed in total by January 17, 2022. Despite the high mortality and morbidity rates attributed to COVID-19, there is little available data on COVID-19 in Rwanda. Most notably, little information is available regarding the causes of the different clinical and imaging manifestations of COVID-19 in Rwanda. Objective: The main objective of this study was to evaluate the relationship between chest CT findings and clinical presentation in patients with COVID-19 pneumonia. Methods: Our study evaluated the CT findings in COVID-19 patients with clinical severity using a 25point visual quantitative assessment. The study addressed the objectives using a retrospective crosssectional design with a quantitative approach. A sample of 384 COVID-19 patients was enrolled using systematic random sampling technique. Statistical analysis was done using Statistical package for the social sciences (SPSS) 25.0. Descriptive statistics were done and presented in form of percentage, mean, &frequency. Logistics regression analysis to identify the odd ratio of the predictive variables of disease severity. Results: The findings of the current study indicate that 316 (83.3%) of participants were aged 36 years and above, 226 (58.9%) were male, and 320 (83.3%) were from the City of Kigali. The most common clinical presentation in patients with COVID-19 pneumonia was cough found in 50.8% of cases followed by shortness of breath (41.1%), and chest pain (40.4%). The findings indicate that the most identified CT scan patterns were Ground glass opacity (GGO) found in 70.3% of participants. Aging [AOR=4.925, 95%CI: 2.495-9.724, P<0.001], Diabetes [AOR=0.216, 95%CI: 1.982-5.054, P<0.001], and CKD [AOR=1.502, 95%CI: 1.090-1.785, P<0.001] were proved to increase CT severity of COVID-19 pneumonia while Vaccination (Beta=-0.268; P<0.001) and Female sex (Beta=-0.098; P=0.032) were associated with decrease in CT severity of COVID-19 pneumonia. Ground glass opacity, septal thickening, and pleural effusion were associated with a poor clinical outcome of participants with COVID19 pneumonia. Conclusion: COVID-19 pneumonia trends more among the male population and in older patients in the urban areas compared to the rural areas. Age, gender, vaccination status, and patient comorbidities like diabetes and CKD are the main determinants of CT severity score in COVID-19 patients. Among the CT patterns, an increase in GGO, septal thickening or pleural effusions were predictors of poor clinical outcome.