{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T11:02:51Z","timestamp":1781521371487,"version":"3.54.1"},"reference-count":47,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Commission of the Sichuan Province Medical Science and Technology Program","award":["24WXXT10"],"award-info":[{"award-number":["24WXXT10"]}]},{"DOI":"10.13039\/100012542","name":"Sichuan Province Science and Technology Support Program","doi-asserted-by":"crossref","award":["2021YJ0242"],"award-info":[{"award-number":["2021YJ0242"]}],"id":[{"id":"10.13039\/100012542","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Quantitative computed tomography (CT) metrics are widely used to assess pulmonary involvement and to predict short-term severity in coronavirus disease 2019 (COVID-19). However, it remains unclear whether baseline artificial intelligence (AI)-based quantitative high-resolution computed tomography (HRCT) metrics of pneumonia burden provide incremental prognostic value for in-hospital composite adverse outcomes beyond routine clinical factors, or whether these imaging-derived markers carry any exploratory signal for long-term severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection among hospitalized patients. Most existing imaging studies have focused on diagnosis and acute-phase prognosis, leaving a specific knowledge gap regarding AI-based quantitative HRCT correlates of early deterioration and subsequent reinfection in this population. To evaluate whether combining deep learning-derived, quantitative, HRCT features and clinical factors improve prediction of in-hospital composite adverse events and to explore their association with long-term reinfection in patients with COVID-19 pneumonia. Methods: In this single-center retrospective study, we analyzed 236 reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients who underwent baseline HRCT. Median follow-up durations were 7.65 days for in-hospital outcomes and 611 days for long-term outcomes. A pre-trained, adaptive, artificial-intelligence-based, prototype model (Siemens Healthineers) was used for pneumonia analysis. Inflammatory lung lesions were automatically segmented, and multiple quantitative metrics were extracted, including opacity score, volume and percentage of opacities and high-attenuation opacities, and mean Hounsfield units (HU) of the total lung and opacity. Patients were stratified based on receiver operating characteristic (ROC)-derived optimal thresholds, and multivariable Cox regression was used to identify predictors of the composite adverse outcome (intensive care unit [ICU] admission or all-cause death) and SARS-CoV-2 reinfection, defined as a second RT-PCR-confirmed episode of COVID-19 occurring \u226590 days after initial infection. Results: The composite adverse outcome occurred in 38 of 236 patients (16.1%). Higher AI-derived opacity burden was significantly associated with poorer outcomes; for example, opacity score cut-off of 5.5 yielded an area under the ROC curve (AUC) of 0.71 (95% confidence interval [CI] 0.62\u20130.79), and similar performance was observed for the volume and percentage of opacities and high-attenuation opacities (AUCs up to 0.71; all p &lt; 0.05). After adjustment for age and comorbidities, selected HRCT metrics\u2014including opacity score, percentage of opacities, and mean HU of the total lung (cut-off \u2212662.38 HU; AUC 0.64, 95% CI 0.54\u20130.74)\u2014remained independently associated with adverse events. Individual predictors demonstrated modest discriminatory ability, with C-indices of 0.59 for age, 0.57 for chronic obstructive pulmonary disease (COPD), 0.62 for opacity score, 0.63 for percentage of opacities, and 0.63 for mean total-lung HU, whereas a combined model integrating clinical and imaging variables improved prediction performance (C-index = 0.68, 95% CI: 0.57\u20130.80). During long-term follow-up, RT-PCR\u2013confirmed reinfection occurred in 18 of 193 patients (9.3%). Higher baseline CT-derived metrics\u2014particularly opacity score and both volume and percentage of high-attenuation opacities (percentage cut-off = 4.94%, AUC 0.69, 95% CI 0.60\u20130.79)\u2014showed exploratory associations with SARS-CoV-2 reinfection. However, this analysis was constrained by the very small number of events (n = 18) and wide confidence intervals, indicating substantial statistical uncertainty. In this context, individual predictors again showed only modest C-indices (e.g., 0.62 for procalcitonin [PCT], 0.66 for opacity score, 0.66 for the volume and 0.64 for the percentage of high-attenuation opacities), whereas the combined model achieved an apparent C-index of 0.73 (95% CI 0.64\u20130.83), suggesting moderate discrimination in this underpowered exploratory reinfection sample that requires confirmation in external cohorts. Conclusions: Fully automated, deep learning-derived, quantitative HRCT parameters provide useful prognostic information for early in-hospital deterioration beyond routine clinical factors and offer preliminary, hypothesis-generating insights into long-term reinfection risk. The reinfection-related findings, however, require external validation and should be interpreted with caution given the small number of events and limited precision. In both settings, combining AI-based imaging and clinical variables yields better risk stratification than either modality alone.<\/jats:p>","DOI":"10.3390\/diagnostics15243156","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T11:17:27Z","timestamp":1765451847000},"page":"3156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["AI-Based Quantitative HRCT for In-Hospital Adverse Outcomes and Exploratory Assessment of Reinfection in COVID-19"],"prefix":"10.3390","volume":"15","author":[{"given":"Xin-Yi","family":"Feng","sequence":"first","affiliation":[{"name":"Department of Radiology, Affiliated Hospital of North Sichuan Medical College,   Nanchong 637000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei-Yao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Affiliated Hospital of North Sichuan Medical College,   Nanchong 637000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si-Yu","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Affiliated Hospital of North Sichuan Medical College,   Nanchong 637000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Heng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin-Yue","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK"},{"name":"CT Collaboration, Siemens-Heathineers, Chengdu 610016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi-Bo","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Affiliated Hospital of North Sichuan Medical College,   Nanchong 637000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Affiliated Hospital of North Sichuan Medical College,   Nanchong 637000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5716-9259","authenticated-orcid":false,"given":"Rui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, Affiliated Hospital of North Sichuan Medical College,   Nanchong 637000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref_1","unstructured":"(2025, July 01). 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