Paper Title
ASSOCIATION BETWEEN ADRENAL GLAND INVOLVEMENT ON INITIAL CHEST CT SCAN AND CLINICAL COURSE IN HOSPITALIZED COVID-19 PATIENTS: A RETROSPECTIVE NESTED CASE-CONTROL STUDY

Abstract
Introduction: The COVID-19 pandemic has posed significant challenges to the global healthcare system, with emerging evidence indicating potential adrenal involvement in severe cases. This retrospective study aimed to explore the relationship between adrenal involvement, as observed on initial chest CT scans, and the clinical outcomes of COVID-19 patients, independent of age, gender, and the extent of pulmonary involvement. Materials and Methods: We included patients with a confirmed diagnosis of COVID-19 who had more than 50% pulmonary parenchyma involvement on initial chest CT scans. Adrenal involvement was assessed through re-evaluation of the CT scans. Two groups were formed: 115 patients with adrenal involvement (case group) and 115 without (control group), matched for age, gender, and pulmonary involvement. Clinical outcomes, including ICU admission, length of hospital stay, and mortality, were analyzed using SPSS-v22 software. Results: Among 363 patients with significant pulmonary involvement, 115 (31.68%) showed signs of adrenal involvement. Patients in the case group had a significantly higher rate of ICU admission (69.57% vs. 45.22%, OR = 2.77 [95% CI: 1.61-4.76], P <0.001) and mortality (55.65% vs. 38.94%, OR = 1.97 [95% CI: 1.16-3.34], P = 0.012) compared to the control group. The mean length of ICU, ward, and hospital stay was similar between the groups (P = 0.648, 0.102, and 0.888). Conclusion: Adrenal involvement identified on initial chest CT scans is associated with a more severe clinical course in COVID-19, including higher ICU admission rates and mortality. Early detection and consideration of adrenal involvement may be crucial for optimizing treatment strategies. Keywords: Adrenal involvement, COVID-19, mortality rate, ICU admission.