Does the Thymus Index Predict COVID-19 Severity? : Journal of Computer Assisted Tomography

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Does the Thymus Index Predict COVID-19 Severity?

Berkan, Ocal MD∗; Kiziloğlu, Ilker MD†; Keles, Ercan MD∗; Duman, Lale MD‡; Bozkurt, Mehmet MD§; Adibelli, Zehra MD∥; Oncel, Guray MD; Berkan, Nevsin MSc#; Ekemen Keles, Yildiz MD∗∗; Jones, Jeremy H. PhD††; Inan, Abdurrahman Hamdi MD‡‡; Solak, Cihan MD§§; Emiroğlu, Mustafa MD∥∥; Yildirim, Mehmet MD¶¶; Dursun, Ayberk MD∥∥; Ilhan, Enver MD¶¶; Camyar, Asuman MD##; Inceer, Ozge MD∗∗∗; Nart, Ahmet MD†; Yilmaz, Mehmet Birhan MD†††

Author Information

From the Departments of ∗Cardiovascular Surgery

†General Surgery, İzmir Çiğli Training and Research Hospital

‡Department of Radiology, Bornova Türkan Özilhan Hospital

§Department of Radiology, Tepecik Education and Research Hospital

∥Department of Radiology, Bozyaka Education and Research Hospital

Department of Radiology, İzmir Çiğli Training and Research Hospital, İzmir, Turkey

#Molecular Biology & Genetics, University of Lorraine, Nancy, France

∗∗Department of Pediatric İnfection Diseases, Tepecik Education and Research Hospital, İzmir

††Department of Academic Writing, Kocaeli University, Umuttepe, İzmit

‡‡Department of Gynecology and Obstetrics, Bornova Türkan Özilhan Hospital, İzmir

§§Department of Radiology, Adana Guney Hospital, Adana

∥∥Department of General Surgery, Tepecik Education and Research Hospital

¶¶Department of General Surgery, Bozyaka Education and Research Hospital

##Department of Allergy and Immunology, İzmir Çiğli Training and Research Hospital

∗∗∗Department of Infectious Disease and Clinical Microbiology, İzmir Çiğli Training and Research Hospital

†††Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey.

Received for publication April 2, 2022; accepted September 20, 2022.

Correspondence to: Ercan Keles, MD, Çiğli Training and Research Hospital, 8780/1. Sk. No:18, 35620, İzmir, Turkey (e-mail: [email protected]).

Author Contributions: Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work: all authors. Drafting the work or revising it critically for important intellectual content: all authors. Final approval of the version to be published: all authors. All authors take responsibility for the article. It acknowledges the contributions of other authors and the publication of the article in this form. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

The authors declare no conflict of interest.

No funding was secured for this study.

Ethics committee approval was obtained. All authors have given consent for the study to be published in the Journal of Computer Assisted Tomography.

Journal of Computer Assisted Tomography 47(2):p 236-243, 3/4 2023. | DOI: 10.1097/RCT.0000000000001425

Abstract

Background 

The COVID-19 (coronavirus disease 2019) pandemic is a global health emergency that is straining health care resources. Identifying patients likely to experience severe illness would allow more targeted use of resources. This study aimed to investigate the association between the thymus index (TI) on thorax computed tomography (CT) and prognosis in patients with COVID-19.

Methods 

A multicenter, cross-sectional, retrospective study was conducted between March 17 and June 30, 2020, in patients with confirmed COVID-19. The patients' clinical history and laboratory data were collected after receiving a signed consent form. Four experienced radiologists who were blinded to each other and patient data performed image evaluation. The appearance of the thymus was assessed in each patient using 2 published systems, including the TI and thymic morphology. Exclusion criteria were lack of initial diagnostic thoracic CT, previous sternotomy, pregnancy, and inappropriate images for thymic evaluation. A total of 2588 patients with confirmed COVID-19 and 1231 of these with appropriate thoracic CT imaging were included. Multivariable analysis was performed to predict the risk of severe disease and mortality.

Results 

The median age was 45 (interquartile range, 33–58) years; 52.2% were male. Two hundred forty-nine (20.2%) patients had severe disease, and 60 (4.9%) patients died. Thymus index was significantly associated with mortality and severe disease (odds ratios, 0.289 [95% confidence interval, 0.141–0.588; P = 0.001]; and 0.266 [95% confidence interval, 0.075–0.932; P = 0.038]), respectively. Perithymic lymphadenopathy on CT imaging had a significantly strong association with grades of TI in patients with severe disease and death (V = 0.413 P = 0.017; and V = 0.261 P = 0.002, respectively). A morphologically assessable thymus increased the probability of survival by 17-fold and the absence of severe disease by 12-fold.

Conclusion 

Assessment of the thymus in patients with COVID-19 may provide useful prognostic data for both disease severity and mortality.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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