Mediastinal lymphadenopathy and prognosis of COVID-19 disease
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Abstract
Background and Objectives: There are conflicting studies on the prevalence of mediastinal lymphadenopathy (LAP) and its relationship to the prognosis of COVID-19 disease. The prevalence varied from 3.4 to 66 percent and more prevalent in patients who died. This study aimed to investigate the mediastinal lymphadenopathy and the disease progression in COVID-19 patients.
Materials and Methods: In this case-control study, 195 COVID-19 patients were divided into two groups, with the mediastinal lymphadenopathy and without it. In these groups, demographic characteristics, underlying diseases, laboratory results, and outcomes were compared.
Results: The median age in the LAP group was higher than the opposite group (62 vs. 58.5; p= 0.037). SpO2 (85% vs. 90%; P <0.001), lymphocyte count (760 vs. 969; p= 0.02), Neutrophil-to-Lymphocyte Ratio (5.53 vs. 4.41; p= 0.02), and ESR (36 vs. 29; p= 0.03) were significantly correlated with the presence of lymphadenopathy, using the Mann-Whitney Wilcoxon rank test. ICU admission (65.71% vs. 36.87; p= 0.003), mechanical ventilation (31.42% vs. 13.75%; p= 0.022), disease severity (65.71% vs. 40%; p <0.01), length of hospital stay (9 vs. 7; p= 0.039) and mortality rate (40% vs. 21.25%; p= 0.034) were more predominantly observed in the LAP group, using the χ2 test. There was no apparent difference in sex and the underlying diseases among the two groups.
Conclusion: This observation showed a relatively high prevalence of mediastinal lymphadenopathy in COVID-19 patients, which was more common in the elderly with low oxygen saturation. Therefore, LAP may lead to further intensive care needs, more use of mechanical ventilation, high severity of disease, and mortality rate.
2. Bulut C, Kato Y. Epidemiology of COVID-19. Turk J Med Sci 2020;50(SI-1): 563-570.
3. Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020;9: 29.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395: 497-506.
5. da Rosa Mesquita R, Francelino Silva Junior LC, Santos Santana FM, Farias de Oliveira T, Campos Alcântara R, Monteiro Arnozo G, et al. Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr 2021;133: 377-382.
6. Rod JE, Oviedo-Trespalacios O, Cortes-Ramirez J. A brief-review of the risk factors for covid-19 severity. Rev Saude Publica 2020;54: 60.
7. Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID‐19 severity: a literature review. Rev Med Virol 2021;31: 1-10.
8. Liu W, Tao Z-W, Wang L, Yuan M-L, Liu K, Zhou L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl) 2020;133: 1032-1038.
9. Pan F, Yang L, Li Y, Liang B, Li L, Ye T, et al. Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. Int J Med Sci 2020;17: 1281-1292.
10. Belice T, Demir I, Yüksel A. Role of neutrophil-lymphocyte-ratio in the mortality of males diagnosed with COVID-19. Iran J Microbiol 2020;12: 194-197.
11. Pirsalehi A, Salari S, Baghestani A, Vahidi M, Khave LJ, Akbari ME, et al. Neutrophil-to-lymphocyte ratio (NLR) greater than 6.5 may reflect the progression of COVID-19 towards an unfavorable clinical outcome. Iran J Microbiol 2020;12: 466-474.
12. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020;215: 87-93.
13. Ojha V, Mani A, Pandey NN, Sharma S, Kumar S. CT in coronavirus disease 2019 (COVID-19): a systematic review of chest CT findings in 4410 adult patients. Eur Radiol 2020;30: 6129-6138.
14. Bao C, Liu X, Zhang H, Li Y, Liu J. Coronavirus disease 2019 (COVID-19) CT findings: a systematic review and meta-analysis. J Am Coll Radiol 2020;17: 701-709.
15. Evison M, Crosbie PAJ, Morris J, Martin J, Barber PV, Booton R. A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA. BMJ Open Respir Res 2014;1(1): e000040.
16. Dabrowska M, Faber K, Tandejko-Burdyna M, Korczynski P, Krenke R. Etiology of mediastinal lymph node enlargement in patients who underwent EBUS-TBNA. Eur Res J 2019;54: PA3095.
17. Burlew JT, Weber C, Banks KP. Anatomy, thorax, mediastinal lymph nodes. StatPearls 2021.
18. Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, et al. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal. BMJ 2020;369: m1328.
19. Valette X, du Cheyron D, Goursaud S. Mediastinal lymphadenopathy in patients with severe COVID-19. Lancet Infect Dis 2020;20: 1230.
20. Li X, Fang X, Bian Y, Lu J. Comparison of chest CT findings between COVID-19 pneumonia and other types of viral pneumonia: a two-center retrospective study. Eur Radiol 2020;30: 5470-5478.
21. Fang X, Li X, Bian Y, Ji X, Lu J. Relationship between clinical types and radiological subgroups defined by latent class analysis in 2019 novel coronavirus pneumonia caused by SARS-CoV-2. Eur Radiol 2020;30: 6139-6150.
22. Taweesedt PT, Surani S. Mediastinal lymphadenopathy in COVID-19: a review of literature. World J Clin Cases 2021;9:2703-2710.
23. Sardanelli F, Cozzi A, Monfardini L, Bnà C, Foà RA, Spinazzola A, et al. Association of mediastinal lymphadenopathy with COVID-19 prognosis. Lancet Infect Dis 2020;20: 1230-1231.
24. Satici C, Cengel F, Gurkan O, Demirkol MA, Altunok ES, Esatoglu SN. Mediastinal lymphadenopathy may predict 30-day mortality in patients with COVID-19. Clin Imaging 2021;75: 119-124.
25. Hani C, Trieu NH, Saab I, Dangeard S, Bennani S, Chassagnon G, et al. COVID-19 pneumonia: a review of typical CT findings and differential diagnosis. Diagn Interv Imaging 2020;101: 263-268.
26. Zhu J, Zhong Z, Li H, Ji P, Pang J, Li B, et al. CT imaging features of 4121 patients with COVID-19: a meta analysis. J Med Virol 2020;92: 891-902.
| Files | ||
| Issue | Vol 13 No 4 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v13i4.6974 | |
| Keywords | ||
| COVID-19; Hematologic disease; Lymphadenopathy; Mediastinal disease; Prognosis | ||
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