%0 Journal Article %A Michael F. Morris %A Yash Pershad %A Paul Kang %A Lauren Ridenour %A Ben Lavon %A Maarten Lanclus %A Rik Godon %A Jan De Backer %A Marilyn K. Glassberg %T Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease %D 2021 %R 10.1183/13993003.04133-2020 %J European Respiratory Journal %P 2004133 %V 58 %N 3 %X Introduction Evidence suggests that vascular inflammation and thrombosis may be important drivers of poor clinical outcomes in patients with COVID-19. We hypothesised that a significant decrease in the percentage of blood volume in vessels with a cross-sectional area between 1.25 and 5 mm2 relative to the total pulmonary blood volume (BV5%) on chest computed tomography (CT) in COVID-19 patients is predictive of adverse clinical outcomes.Methods We performed a retrospective analysis of chest CT scans from 10 hospitals across two US states in 313 COVID-19-positive and 195 COVID-19-negative patients seeking acute medical care.Results BV5% was predictive of outcomes in COVID-19 patients in a multivariate model, with a BV5% threshold below 25% associated with OR 5.58 for mortality, OR 3.20 for intubation and OR 2.54 for the composite of mortality or intubation. A model using age and BV5% had an area under the receiver operating characteristic curve of 0.85 to predict the composite of mortality or intubation in COVID-19 patients. BV5% was not predictive of clinical outcomes in patients without COVID-19.Conclusions The data suggest BV5% as a novel biomarker for predicting adverse outcomes in patients with COVID-19 seeking acute medical care.BV5% derived from chest CT may serve as an imaging biomarker for predicting adverse outcomes in patients with COVID-19 seeking acute medical care https://bit.ly/2Zg18Vv %U https://erj.ersjournals.com/content/erj/58/3/2004133.full.pdf