CXR severity as a predictor for post-COVID-19 related ILD

Abstract

COVID-19 is caused by SARS COV-2, which first emerged in China and spread widely worldwide. Chest X-ray(CXR) is the first-line tool for COVID-19, and it allows initial assessment and follow-up, giving a great insight into the disease course. A high-resolution computed tomography (HRCT) has become essential for the diagnosis of post-COVID related interstitial lung disease (ILD). Our aim was to determine the COVID-19 disease severity using the CXR scoring system and then evaluate whether the severity of admission CXR could predict the presence of post-COVID related ILD. Data were analysed retrospectively for all adult patients presenting to our hospital between August 2020 and December 2021. 44 patients were found with post-COVID related ILD on HRCT which was performed as a result of persistent abnormalities on 6-12 week follow up CXR. We used severity scoring systems which were classified as mild, moderate, and severe depending on the number of lung segments involved. Severity scoring was performed by an experienced radiologist. Each CXR classification was then compared to HRCT findings. A total of 44 patients with COVID-19, 31 men and 13 women were included. The mean age was 67.7 (range 45–93). The following disease patterns were reported on HRCT: ground-glass opacities, traction bronchiectasis, reticulation, fibrosis, consolidation, organizing pneumonia, and honeycombing. When HRCTs were correlated, 18 admission CXRs were classified as mild, 23 as moderate and 3 as severe. This suggests that the severity of admission CXR does not predict the subsequent emergence of post-covid related ILD. We would recommend looking at other possible predictors such as the need for ventilatory support, co-morbidities, and intensive care admissions.