Mediastinal Lymphadenopathy May Predict

30-day Mortality in Patients with COVID-19

Authors: Celal Satici, Ferhat Cengel, Okan Gurkan, Mustafa Asim
Demirkol, Elif Sargin Altunok, & Sinem Nihal Esatoglu

Presenters: Agcong, Chiva, Delcano, Ali,

Pigcaulan, Sanang, Aliman, & Alongan
 INTRODUCTION
There is scarce data on the impact of the
presence of mediastinal lymphadenopathy on
the prognosis of coronavirus-disease 2019
(COVID-19). The study aimed to investigate
whether its presence is associated with
increased risk for 30-day mortality in a large
group of patients with COVID-19.
MATERIAL & METHODS
Study Design and Settings
STUDY DESIGN AND
SETTING and Study Population
STUDY POPULATION

DATA COLLECTION The study performed a retrospective cross-

sectional study at Gaziosmanpasa Training and
IMAGING PROTOCOLS
Research Hospital, University of Health Sciences,
AND TECHNIQUES
Istanbul, Turkey.
IMAGING ANALYSIS
The first coronavirus case was registered in
TREATMENT Turkey on March 11, 2020. Immediately, Turkish Ministry
of Health has prepared a COVID-19 guideline for
OUTCOME healthcare providers which has been updated several
times according to scientific developments.
STATISTICAL ANALYSIS
MATERIAL & METHODS

STUDY DESIGN AND

Data Collection & Imaging
SETTING Protocols and Techniques
STUDY POPULATION

DATA COLLECTION
All data were obtained from electronic
IMAGING PROTOCOLS medical records.
AND TECHNIQUES
The imaging parameters used were as follows;
IMAGING ANALYSIS
tube voltage; 120 kVp, tube current (regulated by
automatic dose modulation); 80–200 mAs, slice
TREATMENT
thickness; 5 mm, matrix; 512 × 512, field of view; 350
mm × 350 mm.
OUTCOME

STATISTICAL ANALYSIS
MATERIAL & METHODS

STUDY DESIGN AND

Imaging Analysis and
SETTING Treatment
STUDY POPULATION
All CT images were reviewed by two
DATA COLLECTION radiologists with 9 and 12 years of experience in
interpreting chest CT imaging [FC and OG,
IMAGING PROTOCOLS
respectively], on a in Picture Archiving and
AND TECHNIQUES
Communication System (PACS) imaging workstation
IMAGING ANALYSIS (Infinitt PACS; Infinitt Healthcare, Seoul, Korea).

TREATMENT Hydroxychloroquine, azithromycin, favipiravir,

tocilizumab, and enoxaparin were used.
OUTCOME

STATISTICAL ANALYSIS
MATERIAL & METHODS

STUDY DESIGN AND

Outcome and Statistical
SETTING Analysis
STUDY POPULATION

DATA COLLECTION
The primary outcome was to assess whether
IMAGING PROTOCOLS if the presence of enlarged mediastinal
AND TECHNIQUES lymphadenopathy is associated with increased risk for
30-day mortality.
IMAGING ANALYSIS
Descriptive statistics, categorical data,
TREATMENT continuous data, median and interquartile range, chi-
square test, t-test, and Mann Whitney U test were used.
OUTCOME

STATISTICAL ANALYSIS
RESULTS
Patients with Enlarged Mediastinal
Lymphadenopathy vs Those Without

Enlarged mediastinal lymphadenopathy was detected in 60 patients (9.2%). The characteristics

of the patients with and without enlarged mediastinal lymphadenopathy are summarized:
 Deceased vs Survived Patients

After performing multivariate analysis; older age (OR:3.74, 95% CI: 2.06–6.79; p < 0.001), the presence of
enlarged mediastinal lymphadenopathy (OR:2.38, 95% CI:1.13–4.98; p = 0.02) and consolidation on CT scan
(OR:1.93, 95% CI: 1.09–3.40; p = 0.02) were found to be independent predictors of 30-day mortality.
 Number and Distribution of
Enlarged Mediastinal
Lymphadenopathy

Among the 60 patients with

enlarged mediastinal lymphadenopathy,
the distribution and the median
number of enlarged mediastinal
lymphadenopathies were similar
between dead and alive patients.
DISCUSSION
The data of the study showed that older age,
the presence of consolidation and enlarged mediastinal
lymphadenopathy on CT scan were independently
associated with increased 30-day mortality. The
distribution and the median number of enlarged
mediastinal lymphadenopathies did not differ between
dead and alive patients, however patients who died
tended to have more lymph nodes than those who
survived.
 The study has several limitations:
DISCUSSION
• it has a cross-sectional design and longitudinal
assessment of CT scans at different stages was not
performed.
• data on smoking status was not available
• researchers cannot be sure that patients had already
an enlarged mediastinal lymphadenopathy previously.

However, its strength was that radiological

findings on standardized chest CT scan were blindly
evaluated by two experienced radiologists and
interobserver reliability was almost perfect.
 CONCLUSION

With the large group of hospitalized patients with COVID-19, this

study found that in addition to older age and consolidation pattern on CT
scan, enlarged mediastinal lymphadenopathy were independently
associated with increased mortality. Mediastinal evaluation should be
performed in all patients with COVID-19.