Does radiographic evaluation pulmonary edema score predict intensive care admission in COVID-19 patients presenting to the emergency department? A retrospective single-center observational study

Abstract

Aim: COVID-19 disease can progress from pneumonia to acute respiratory distress syndrome (ARDS). Performing computed tomography on all patients is expensive and exposes them to high radiation. The simple and reproducible Radiographic Evaluation Pulmonary Edema (RALE) score, used in ARDS and acute pulmonary edema in the emergency department, can predict the severity of the disease in COVID-19 patients. Material and Method: In our study, a total of 221 COVID-19 patients we followed up between July-November, 2021 were evaluated retrospectively. The patients were divided into two as Intensive care hospitalization and no intensive care hospitalization. Results: Ninety-five (43%) patients were admitted to the intensive care unit. The mean age (p<.001), white blood cell count (WBC) (p=.001), neutrophil count (p<.001), RALE score, and the number of hospitalization days of the patients admitted to the intensive care unit were higher (p<.001). These findings were positively correlated with the RALE score (p<.001). Age (p<.001), RALE score (p=.022), WBC (p=.029), and neutrophil count (p=.004) were independent risk factors in the multivariate analysis of factors affecting intensive care admission. RALE score cut-off value in predicting intensive care unit admission was ≥10.5. In the analysis with an Area Under the Curve value of 0.716, the application of this threshold resulted in a sensitivity of 67.4% and a specificity of 69.8%. Conclusion: In conclusion, performing chest computed tomography in all patients admitted to the emergency department with COVID-19 disease increases the cost and exposure to radiation. The simple and recalculated RALE score can be used to predict intensive care admission in COVID-19 pneumonia.