Generalized additive mixed model to evaluate the association between total pulmonary infection volume and volume ratio, and clinical types, in patients with COVID-19 pneumonia: a propensity score analysis

Objectives To investigate the association between longitudinal total pulmonary infection volume and volume ratio over time and clinical types in COVID-19 pneumonia patients. Methods This retrospective review included 367 patients with COVID-19 pneumonia. All patients underwent CT examination at baseline and/or one or more follow-up CT. Patients were categorized into two clinical types (moderate and severe groups). The severe patients were matched to the moderate patients via propensity scores (PS). The association between total pulmonary infection volume and volume ratio and clinical types was analyzed using a generalized additive mixed model (GAMM). Results Two hundred and seven moderate patients and 160 severe patients were enrolled. The baseline clinical and imaging variables were balanced using PS analysis to avoid patient selection bias. After PS analysis, 172 pairs of moderate patients were allocated to the groups; there was no difference in the clinical and CT characteristics between the two groups (p > 0.05). A total of 332 patients, including 396 CT scans, were assessed. The impact of total pulmonary infection volume and volume ratio with time was significantly affected by clinical types (p for interaction = 0.01 and 0.01, respectively) using GAMM. Total pulmonary infection volume and volume ratio of the severe group increased by 14.66 cm(3) (95% confidence interval [CI]: 3.92 to 25.40) and 0.45% (95% CI: 0.13 to 0.77) every day, respectively, compared to that of the moderate group. Conclusions Longitudinal total pulmonary infection volume and volume ratio are independently associated with the clinical types of COVID-19 pneumonia.

Automated summary

The study investigated the association between longitudinal total pulmonary infection volume and volume ratio over time and clinical types in COVID-19 pneumonia patients. Propensity score analysis was used to match severe patients to moderate patients and balance baseline clinical and imaging variables. The results showed that total pulmonary infection volume and volume ratio were significantly associated with clinical types, with the severe group experiencing a higher increase over time compared to the moderate group.