Background

It is known that  COVID-19  is  associated  with coagulopathy and endothelial dysfunction. Dilation of main pulmonary artery diameter (MPAD) as measured on Chest CT is well correlated with pulmonary vasculature diseases in the non COVID-19 era. 

Aim

To  investigate  if  the  MPAD  dilation on admission is correlated with COVID-19  clinical outcome and can be used as a prognostic biomarker for disease severity.

Methods

301 COVID-19   in- patients  from  our Department  were retrospectively studied . MPAD diameter and extent of parenchymal disease on admission has been assessed blindly by two independent radiologists. Patients were divided in two groups according to MPAD;  group A, normal - mild dilation (MPAD<31mm), group B, moderate -severe dilation (MPAD?31mm).

Clinical outcome included ARDS onset, need for intubation or non-invasive-ventilation (NIV) or death until day 28.

Chi-squared and Fischer's exact tests were applied.

Results

Disease severity was graded 1 in 3 patients  (1%), 2 in 177 (58,8%), 3 in 106 (35,22%) and 4 in 15 (4,98%), while median CCI was 1 (25th-75th percentiles 0-3, range 0-8) and median CT severity was 9 (25th-75th percentiles 6-14, range 0-20) at the time of admission.

27.59% of Group B patients compared to 14.02% of Group A patients (p-value<0,05) had a worse outcome. Moreover, 10,34% of Group B vs 3,74% of Group A patients (p-value<0,05) needed intubation or NIV  while 5,75% of Group B vs 4,67% of Group A patients died (p-value NS) and 4,6% of Group B vs 4,67% of Group A experienced ARDS (p-value NS).

Conclusion

COVID-19 patients with moderate or severe dilated MPAD as measured on Thorax CT on admission are more likely to develop a poor clinical outcome.