P0828CKD STAGE DISTRIBUTION IN AN ITALIAN PROVINCE; SEVEN YEARS OF FOLLOW UP

Abstract Background and Aims Chronic kidney disease (CKD) is a chronic illness with important implications for the health of the population and for the commitment of resources by public health services. CKD staging makes it possible to assess the severity of the disease and its distribution in the population. The distribution of the stages of CKD diagnosed through hospitalization were analyzed using administrative database of the Local Health Authority of a province with a population of about 1 million inhabitants in northern Italy. Method Patients with hospital discharge with a diagnosis of CKD (ICD9CM 5851, 5852, 5853, 5854) in 2011- 2012 years, without dialysis treatment, neither transplantation procedure nor acute renal failure were selected. Demographic characteristics, comorbidities, dialysis treatment, drugs prescription and nephrological follow-up were investigated. This cohort of patients was examined over a 7-year period (2011-2017). Stage five was not considered to avoid possible misunderstanding with five D stage. Results 1808 patients diagnosed with CKD were extracted from the 2011-2017 administrative database; of these, 1267 had a diagnosis with the CKD stage specification. The distribution of 1267 patients in the CKD stages at the first hospital discharge was as follows: 7.4% stage 1, 30.9% stage 2, 42.3% stage 3, 19.3% stage 4. The 832 patients described in the study were still alive as of Jan. 1, 2013 while 435 (34.3%) died by Dec. 31, 2012. Until Dec. 31, 2017, 503 of the 832 patients died representing the 52.8% of stage 1 patients, 62% of stage 2 patients, 58.2% of stage 3 patients, 66.4% of stage 4 patients. Males were the most prevalent gender (58.5%), without any significant difference into CKD stages. Our patients have a fairly high age as can be seen from the table 1. The presence of co-morbidities was assessed either directly for the main risk factors or by the modified Charlson index (MCI) for CKD patients. The average value of the MCI is 3.8 ± 3.1 for all patients and 3.4 ±3.0 for stage 1, 4.1 ± 3.3 for stage 2, 3.7 ± 3.1 for stage 3, 3.7 ± 2.9 for stage 4, with maximum values of 12.0, 17.0, 16.0 and 14.0 respectively. About 40% of patients had diabetes mellitus, with the highest prevalence in stage 4 (49.3%) and the lowest in stage 1 (25%). Cardiovascular disease was distributed almost equally among all patients with a value between 82% in stage 1 and 86.3% in stage 4. Cancer were present in 26.3% of patients with similar values in all stages. Just about 9% of patients underwent dialysis treatment for achieving ESRD, with a percentage of 5.6% among patients in stage 1 and 17.1% among those in stage 4. Hemodialysis represented first choice treatment (86%) compared with peritoneal one (14%). Time from the diagnosis of CKD to the first dialysis was variable with an average of 3.4 ±1.7 years; the longest interval for patients in stage 1 (5.1±1.8) and the shortest (3.0 ±1.6) for patients in stage 4. The number of nephrological visits at renal units was analyzed for an assessment of the extent of follow-up and prevention upon reaching the ESRD (table2). More than 90% of patients had prescribed drugs antagonists of the renin angiotensin system, in all stages of CKD; other antihypertensive drugs (Ca channel blockers and peripheral vasodilators) had a similar prescription level. Anemia control drugs (ESA and iron) had an incremental prescription with stages of the disease from 51.4% in stage 1 to 74% in stage 4, similarly to Ca-P metabolism control drugs ranging from 44.4% in stage 1 to 67.8% in stage 4. Conclusion Correct staging of CKD is very important to assess the prognosis of patients, but the major determinants of outcome are comorbidities and age of the patients. The cohort examined has a high mortality rate, far higher than reported in the literature for CKD. It should be noted that the sample was identified by hospitalization for cardiovascular diseases more than 50% complicated by diabetes and hypertension, so death represents the main outcome and not ESRD.

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Unmet needs for CKD care: from the general population to the CKD clinics. How many patients are we missing?

Clinical Kidney Journal ◽

10.1093/ckj/sfab055 ◽

2021 ◽

Author(s):

Massimo Torreggiani ◽

Antoine Chatrenet ◽

Antioco Fois ◽

Jean Philippe Coindre ◽

Romain Crochette ◽

...

Keyword(s):

General Population ◽

Unmet Needs ◽

Population Studies ◽

Annual Salary ◽

Number Of Patients ◽

Stage 4 ◽

Ckd Stage ◽

Nephrology Care ◽

Stage 1

Abstract Introduction Prevalence of chronic kidney disease (CKD) varies around the world. Little is known on the discrepancy between general population needs and nephrology offer of care. We aimed to contribute to filling this gap and propose a means to infer the number of patients needing follow-up. Methods All patients undergoing at least one nephrology consultation in 2019 were enrolled. We used the ratio between CKD stage 3 and 4 reported in the literature, and considered that only 25% to 50% of CKD stage-3 patients have progressive CKD, to hypothesize different scenarios to estimate the number of CKD stage-3 patients still needing nephrology follow-up. Results 1992 CKD patients were followed-up in our Center (56.93% males; age 66.71 ± 18.32 years; 16.82% stage-1; 14.66% stage-2; 39.46% stage-3; 19.88% stage-4; 7.68% stage-5). The ratio between stage 3 and 4 in population studies ranged from 7.72 to 51.29, being 1.98 in our center. Hypothesizing that we followed-up 100%, 70% or 50% of CKD stage-4 patients, 528 to 2506 CKD stage-3 patients in our area would need nephrology follow-up (1885 to 8946 per million population). Three to seventeen additional nephrologists per million population would be necessary to fully cover the need for care. Conclusions The number of patients with CKD stage-3 who would benefit from nephrology care is high. Considering that one patient-year of delay of dialysis could cover a nephrologist’s annual salary, interventions aimed to improve care of advanced CKD may be economically sound.

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The Copenhagen chronic kidney disease echo study (COInCYDE)

European Heart Journal ◽

10.1093/ehjci/ehaa946.3326 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Landler ◽

S Bro ◽

B Feldt-Rasmussen ◽

D Hansen ◽

A.L Kamper ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cardiac Function ◽

Left Ventricular ◽

Funding Source ◽

Ckd Stage ◽

Significant Difference ◽

Stage 1

Abstract Background The cardiovascular mortality of patients with chronic kidney disease (CKD) is 2–10 times higher than in the average population. Purpose To estimate the prevalence of abnormal cardiac function or structure across the stages CKD 1 to 5nonD. Method Prospective cohort study. Patients with CKD stage 1 to 5 not on dialysis, aged 30 to 75 (n=875) and age-/sex-matched controls (n=173) were enrolled consecutively. All participants underwent a health questionnaire, ECG, morphometric and blood pressure measurements. Blood and urine were analyzed. Echocardiography was performed. Left ventricle (LV) hypertrophy, dilatation, diastolic and systolic dysfunction were defined according to current ESC guidelines. Results 63% of participants were men. Mean age was 58 years (SD 12.6 years). Mean eGFR was 46.7 mL/min/1,73 m (SD 25.8) for patients and 82.3 mL/min/1,73 m (SD 13.4) for controls. The prevalence of elevated blood pressure at physical exam was 89% in patients vs. 53% in controls. Patients were more often smokers and obese. Left ventricular mass index (LVMI) was slightly, albeit insignificantly elevated at CKD stages 1 & 2 vs. in kontrols: 3.1 g/m2, CI: −0.4 to 6.75, p-value 0.08. There was no significant difference in LV-dilatation between patients and controls. Decreasing diastolic and systolic function was observed at CKD stage 3a and later: LVEF decreased 0.95% (CI: −1.5 to −0.2), GLS increased 0.5 (CI: 0.3 to 0.8), and OR for diastolic dysfunction increased 3.2 (CI 1.4 to 7.3) pr. increment CKD stage group. Conclusion In accordance to previous studies, we observe in the CPHCKD cohort study signs of early increase of LVMI in patients with CKD stage 1 & 2. Significant decline in systolic and diastolic cardiac function is apparent already at stage 3 CKD. Figure 1. Estimated GFR vs. GLS & histogram of GLS Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Capital Region of Denmark

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The Evaluation of the Children with Renal Transplant: Single Centre Experience

10.38092/jpa-2020-760856 ◽

2020 ◽

pp. 90-93

Author(s):

Muhammed Mustafa Özdemir ◽

Ayşe Seda Pınarbaşı ◽

Neslihan Günay ◽

Aynur Gencer-Balaban ◽

Sibel Yel ◽

...

Keyword(s):

Renal Transplantation ◽

Chronic Kidney Disease Stage ◽

Clinic Visit ◽

Disease Stage ◽

Single Centre Experience ◽

Ckd Stage ◽

Underlying Causes ◽

Stage 1 ◽

Nephrotic Range Proteinuria

Objective: This study aimed to evaluate patients with renal transplantation in terms of clinical and laboratory parameters. Material and Methods: This study was performed retrospectively with records of 48 patients who underwent renal transplantation before 18 years of age, between June 2008 and July 2019. Results: Congenital malformations of the urinary tract were the most common underlying causes of chronic kidney disease stage 5. Surgical complications occurred in 33.4% of the patients and BK viremia was the most common opportunistic viral infection during the follow-up. At the last clinic visit, 57.4% of our patients had CKD stage 1, hypertension and nephrotic range proteinuria were seen in eight and two patients, respectively. Conclusion: Although renal transplantation is the most ideal renal replacement therapy, patients may experience various complications during the follow-up. Therefore, they should be monitored regularly

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Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013–2014

Public Health Action ◽

10.5588/pha.19.0007 ◽

2019 ◽

Vol 9 (4) ◽

pp. 142-147

Author(s):

G. Ngoga ◽

P. H. Park ◽

R. Borg ◽

G. Bukhman ◽

E. Ali ◽

...

Keyword(s):

Communicable Disease ◽

Health Centers ◽

Blood Pressure Targets ◽

District Hospitals ◽

Significant Difference ◽

Stage 1 ◽

To Receive ◽

Non Communicable Disease

Setting: Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda.Objective: To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home.Design: A retrospective descriptive cohort study using routinely collected data involving adult patients aged 18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014.Results: Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs.Conclusion: By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.

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P0747STRESS ERGOMETRY PERFORMANCE AND ABDOMINAL AORTIC CALCIFICATION PREDICT PATIENT OUTCOMES IN CKD STAGE 4-5

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0747 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Roosa Lankinen ◽

Markus Hakamäki ◽

Kaj Peter Metsarinne ◽

Jussi Pärkkä ◽

Tapio Hellman ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Work Load ◽

Abdominal Aortic Calcification ◽

Abdominal Aortic ◽

Stage 4 ◽

Ckd Stage ◽

Maximal Stress ◽

Artery Disease

Abstract Background and Aims Patients with chronic kidney disease (CKD) stage 4-5 have an increased risk of cardiovascular morbidity and mortality. Method We recruited 174 consecutive patients with CKD stage 4-5 between 2013 and 2017 into a prospective follow-up study assessing arterial disease, quality of life, mortality and their predictors. Together with baseline medical data, standard maximal bicycle ergometry stress testing, abdominal aortic calcification score (AAC) and echocardiography was collected. Patients were followed up for mean 42 months. Results Mean age at recruitment was 61 years, 54 (31%) were women and estimated glomerular filtration rate (eGFR) was 12.9 ml/min. Altogether, 36 (21%) patients died during follow-up with a mean time to death of 835 days. At baseline, all but one patient were hypertensive, 75 patients had diabetes and 21 patients had coronary artery disease. Mean AAC was 6.27±5.68 and work load of the last 4 minutes of maximal stress (WMAX) was 83.7±36.5W, respectively. In the multivariate proportional hazard models pro-BNP [1.98 (95% CI 1.36 – 2.90), p=0.0004], WMAX [HR 0.45 (95% CI 0.27 – 0.77), p=0.0033], AAC [HR 2.51 (95% CI 1.37 – 4.61), p=0.0030], E/e’ –ratio [HR 1.66 (95% CI 1.08 – 2.56), p=0.0221] and albumin [HR 0.59 (95% CI 0.39 – 0.90), p=0.0134] were significant predictors for mortality when adjusted with age, sex, diabetes and previous coronary artery disease. Patients who perished, especially those who died in less than 2 years, within follow-up had significantly higher AAC and lower WMAX compared to those surviving to the end of the study (Figure 1). Conclusion Maximal stress ergometry test work load and AAC are associated with patient survival in severe CKD.

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Cardiovascular Determinants of Mortality in Advanced Chronic Kidney Disease

American Journal of Nephrology ◽

10.1159/000509582 ◽

2020 ◽

Vol 51 (9) ◽

pp. 726-735

Author(s):

Roosa Lankinen ◽

Markus Hakamäki ◽

Kaj Metsärinne ◽

Niina S. Koivuviita ◽

Jussi P. Pärkkä ◽

...

Keyword(s):

Coronary Artery Disease ◽

Aortic Calcification ◽

Abdominal Aortic Calcification ◽

Advanced Chronic Kidney Disease ◽

Abdominal Aortic ◽

Calcification Score ◽

Stage 4 ◽

Ckd Stage ◽

Artery Disease

Background: Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study. Methods: One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients. Results: The duration of follow-up was 42 ± 17 months (range 134–2,217 days). The mean age was 61 ± 14 years, and the estimated glomerular filtration rate was 12 (11–15) mL/min/1.73 m2. Thirty-six (21%) patients died during follow-up (time to death 835 ± 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score, E/e′ ratio, and albumin. Conclusion: Stress ergometry performance, abdominal aortic calcification score, E/e′ of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.

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Changes in Metamorphopsia, Visual Acuity, and Central Macular Thickness after Epiretinal Membrane Surgery in Four Preoperative Stages Classified with OCT B-Scan Images

Journal of Ophthalmology ◽

10.1155/2019/7931654 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Jianbo Mao ◽

Hanfei Wu ◽

Chenyi Liu ◽

Chenting Zhu ◽

Jimeng Lao ◽

...

Keyword(s):

Visual Acuity ◽

Macular Thickness ◽

Final Visit ◽

Central Macular Thickness ◽

Epiretinal Membranes ◽

Stage 4 ◽

Significant Difference ◽

Three Stages ◽

B Scan Images

Purpose. To observe the changes in metamorphopsia, visual acuity, and central macular thickness (CMT) in patients undergoing vitrectomy for idiopathic epiretinal membranes (iERM); all of which were preoperatively stratified into 4 stages according to the anatomical structure of the macula seen on the optical coherence tomography (OCT) b-scan images. Methods. A total of 108 eyes of 106 patients were included. We evaluated and classified the severity of each preoperative ERM based on OCT. Changes in the best-corrected visual acuity (BCVA), metamorphopsia, and CMT were studied by comparing the pre- and postoperative measurements. The follow-up time was at least 6 months. Results. There were 41 eyes at stage 2, 35 at stage 3, 32 at stage 4, and none at stage 1. BCVA and metamorphopsia significantly improved at the final visit in all patients (P<0.01). However, comparing the pre- and postoperative measurements at each stage, only the BCVA and CMT improved significantly for all stages (P<0.001). For stages 2 and 3 ERMs, the horizontal (MH) and vertical (MV) metamorphopsia scores decreased significantly after surgery (P<0.05). No significant difference was found in either MH or MV for stage 4 ERMs (P both >0.05). The preoperative BCVA, MH, and CMT had significant difference among the three stages (P<0.05). Similarly, the postoperative values in the three variables mentioned above also had significant difference among the three stages (P<0.05). For stage 2 ERMs, the baseline MH and MV were positively correlated with the baseline CMT. The MH and MV at the final follow-up also presented a significant positive correlation with the baseline CMT. For stage 3 ERMs, only the baseline MV showed significant correlation with the CMT. Conclusion. Categorization of the preoperative ERMs is a useful method to predict the postoperative improvement in metamorphopsia, which would aid in surgical decisions for patients with ERMs.

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P200 Arterial stiffness in patients with mild-to-moderate renal impairment

European Heart Journal ◽

10.1093/ehjci/ehz872.072 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

A B Md Radzi ◽

S S Kasim

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Stiffness ◽

Medical Center ◽

Linear Regression Analysis ◽

Younger Age ◽

Stage 4 ◽

Ckd Stage ◽

Significant Difference ◽

The Mean

Abstract Background Arterial damage in chronic kidney disease (CKD) is characterized by aortic stiffness. This is seen in elderly patients with advanced CKD. The association between arterial stiffness and early CKD is not well established. Objective: We aimed to study arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease (CKD) stage 2 to 4 and normal renal function in younger-age population. Design and Method: Patients with confirmed CKD stage 2 to 4 were recruited from various clinics from Universiti Teknologi MARA Medical Center, Sungai Buloh, Malaysia from 1st August 2015 until 31st January 2018. Sociodemographic and anthropometric indices were recorded on recruitment. Each patient underwent carotid-femoral (aortic) PWV measurement to determine arterial stiffness. PWV is determined using a one-probe device (SphygmoSore XCEL). Results: 87 patients with CKD stage 2–4 and 87 control patients were recruited. The mean age was 47 ± 5.4 years. CKD patients had a higher mean PWV (7.8 m/s ± 1.7) than healthy controls (5.6 m/s ± 1.0) (p < 0.001, 95% CI –2.59, –1.77). There was significant difference of mean PWV between control (5.6 m/s ± 1.0) and CKD stage 2 (7.6 m/s ± 1.5) (p < 0.001, 95% CI –2.40, –1.49). Our results showed a stepwise increase in PWV from control subjects, CKD stage 2 through stage 4 (p < 0.001). The mean difference of PWV between CKD stage 2 (7.6 m/s, ± 1.5) and stage 4 (9.0 m/s, ± 0.8) was 1.43 (p < 0.001, 95% CI –2.50, -0.35). There was significant difference of mean PWV between diabetes mellitus (DM) (8.2 m/s ± 1.8) and non-DM (7.3 m/s ± 1.3) patients with CKD stage 2–4 (p = 0.022, 95% CI –1.50, –0.12). Mutiple linear regression analysis showed only age (β = 0.078, p = 0.014), mean arterial pressure (MAP) (β = 0.031, p = 0.007) and diuretics usage as the combination antihypertensive medication (β = 0.839, p = 0.018) were independently associated with PWV (r2 = 0.249, p < 0.001). Conclusions: This study shows that arterial stiffness as assessed by PWV occurs early in CKD patient and increased arterial stiffness occurs in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger age population.

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Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01719-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tapio Hellman ◽

Markus Hakamäki ◽

Roosa Lankinen ◽

Niina Koivuviita ◽

Jussi Pärkkä ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

P Wave ◽

Stage 4 ◽

Ckd Stage ◽

Severe Chronic Kidney Disease ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

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Usage of Compromised Lung Volume in Monitoring Steroid Therapy on Severe COVID-19

10.21203/rs.3.rs-698051/v1 ◽

2021 ◽

Author(s):

Ying Su ◽

Ze-song Qiu ◽

Jun Chen ◽

Min-jie Ju ◽

Guo-guang Ma ◽

...

Keyword(s):

Steroid Therapy ◽

Lung Volume ◽

Quantitative Computed Tomography ◽

Hounsfield Unit ◽

Ct Scans ◽

Quantitative Ct ◽

Longitudinal Cohort ◽

Stage 4 ◽

Stage 1

Abstract BackgroundQuantitative computed tomography (QCT) analysis may serve as a tool for assessing the severity of coronavirus disease 2019 (COVID-19) and for monitoring its progress. The present study aimed to assess the association between steroid therapy and quantitative CT parameters in a longitudinal cohort with COVID-19.MethodsBetween February 7 and February 17, 2020, 300 chest CT scans from 72 patients with severe COVID-19 were retrospectively collected and classified into five stages according to the interval between hospital admission and follow-up CT scans: Stage 1 (at admission); Stage 2 (3–7 days); Stage 3 (8–14 days); Stage 4 (15–21 days); and Stage 5 (22–31 days). QCT was performed using a threshold-based quantitative analysis to segment the lung according to different Hounsfield unit (HU) intervals. The primary outcomes were changes in percentage of compromised lung volume (%CL, –500 to 100 HU) at different stages. Multivariate Generalized Estimating Equations were performed after adjusting for potential confounders.ResultsOf 72 patients, 31 patients (43.1%) received steroid therapy. Steroid therapy was associated with a decrease in %CL (-3.27% [95% CI, -5.86 to -0.68, P = 0.01]) after adjusting for duration and baseline %CL. Associations between steroid therapy and changes in %CL varied between different stages or baseline %CL (all interactions, P < 0.01). Steroid therapy was associated with decrease in %CL after stage 3 (all P < 0.05), but not at stage 2. Similarly, steroid therapy was associated with a more significant decrease in %CL in the high CL group (P < 0.05), but not in the low CL group.ConclusionsSteroid administration was independently associated with a decrease in %CL, with interaction by duration or disease severity in a longitudinal cohort. The quantitative CT parameters, particularly compromised lung volume, may provide a useful tool to monitor COVID-19 progression during the treatment process. Trial registration: Clinicaltrials.gov, NCT04953247. Registered July 7, 2021, https://clinicaltrials.gov/ct2/show/NCT04953247

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