Chest Radiograph Score Research Articles

Risk stratification of hospital admissions for COVID-19 pneumonia by chest radiographic scoring in a Johannesburg tertiary hospital.

Chest radiographic scoring systems for COVID-19 pneumonia have been developed. However, little is published on the utilityof these scoring systems in low- and middle-income countries. To perform risk stratification of COVID-19 pneumonia in Johannesburg, South Africa (SA), by comparing the Brixia score withclinical parameters, disease course and clinical outcomes. To assess inter-rater reliability and developing predictive models of the clinicaloutcome using the Brixia score and clinical parameters. Retrospective investigation was conducted of adult participants with established COVID-19 pneumonia admitted at a tertiaryinstitution from 1 May to 30 June 2020. Two radiologists, blinded to clinical data, assigned Brixia scores. Brixia scores were compared withclinical parameters, length of stay and clinical outcomes (discharge/death). Inter-rater agreement was determined. Multivariable logisticregression extracted variables predictive of in-hospital demise. The cohort consisted of 263 patients, 51% male, with a median age of 47 years (interquartile range (IQR) = 20; 95% confidenceinterval (CI) 46.5 - 49.9). Hypertension (38.4%), diabetes (25.1%), obesity (19.4%) and HIV (15.6%) were the most common comorbidities.The median length of stay for 258 patients was 7.5 days (IQR = 7; 95% CI 8.2 - 9.7) and 6.5 days (IQR = 8; 95% CI 6.5 - 12.5) for intensivecare unit stay. Fifty (19%) patients died, with a median age of 55 years (IQR = 23; 95% CI 50.5 - 58.7) compared with survivors, of medianage 46 years (IQR = 20; 95% CI 45 - 48.6) (p=0.01). The presence of one or more comorbidities resulted in a higher death rate (23% v. 9.2%;p=0.01) than without comorbidities. The median Brixia score for the deceased was higher (14.5) than for the discharged patients (9.0)(p<0.001). Inter-rater agreement for Brixia scores was good (intraclass correlation coefficient 0.77; 95% CI 0.6 - 0.85; p<0.001). A modelcombining Brixia score, age, male gender and obesity (sensitivity 84%; specificity 63%) as well as a model with Brixia score and C-reactiveprotein (CRP) count (sensitivity 81%; specificity 63%) conferred the highest risk for in-hospital mortality. We have demonstrated the utility of the Brixia scoring system in a middle-income country setting and developed the first SArisk stratification models incorporating comorbidities and a serological marker. When used in conjunction with age, male gender, obesityand CRP, the Brixia scoring system is a promising and reliable risk stratification tool. This may help inform the clinical decision pathway inresource-limited settings like ours during future waves of COVID-19.

Differential Radiographic Chest Findings in COVID-19 Positive Patients with and Without Comorbidities.

The pandemic of Covid-19 resulted in significant morbidity and mortality, especially in those with pre-existing diseases like diabetes mellitus, cardiovascular diseases, etc., primarily due to extensive pulmonary involvement. The chest radiograph is the first imaging tool used in all Covid-19 patients. Hence, in this study, we attempt to understand and evaluate the role of the chest radiograph in Covid-19 patients with and without coexisting diseases. Our study included RTPCR-positive Covid-19 patients with comorbidities (560 cases) and without comorbidities (145 controls), viz. diabetes mellitus, hypertension, coronary artery disease, or thyroid disease. All controls and cases had chest radiographs with simple fractional zonal scores in a predesigned proforma. Statistical evaluation of chest radiograph scores was compared with and within groups. Among the controls, approximately 63.5% revealed pulmonary findings on chest radiographs contrary to 77% among cases. No statistical differences were noted among controls and cases based on age and gender. The presence of pleural effusion was noted as a significant factor affecting the score and hence the prognosis in both controls and cases. Statistically significant differences were noted in SFZ scores between controls and various case groups. Chest radiograph scores in Covid-19 disease are higher in patients with comorbidities at the time of presentation, most marked in those with both hypertension and thyroid disease followed by those with hypertension and coronary artery disease. Lower zone predominance is seen in all patients including those with and without comorbidities. The chest radiograph scores become statistically significant with more than one existing comorbidity.

"Keep it simple - a lesson from COVID-19": highlighting the utility of chest X-rays in ARDS-associated illnesses through the Zonal Scoring System.

The post-pandemic era calls for appropriate literature on chest X-ray score cut-offs, enabling swift categorization and faster radiological reporting of patients with acute respiratory distress syndrome (ARDS)-like illnesses, hence prompting healthcare equity in low-resource centres where extortionate modalities of imaging such as computed tomography (CT) are unavailable. In this study, we aim to bridge the literature gap using the versatile zonal scoring system. This retrospective cohort study uses data from 751 COVID-19 RT-PCR+ patients. Concordant chest radiograph (CXR) scores were reported, and inter-rater reliability was measured using kappa indices. receiver operating characteristic curves were used to establish cut-off scores for the outcomes of interest: mild or severe disease, admission to an intensive care unit (ICU), and intubation. Categorical data were expressed using means and percentages, and c2 or t-tests were used for comparison at an a level of 0.05. Unadjusted odds ratios for each outcome of interest vs. CXR score and comorbidity were then calculated using binary logistic regression. CXR findings included infiltrates (46.07%), pleural effusions (7.05%), consolidation and fibrosis (4.43%), pneumothoraces (2.71%), and cardiomegaly (2.26%). Most patients had an index CXR score of 0 (54.19%). The index cut-off score of ≤ 1 (82.95, 81.68) was established for mild disease, ≥ 4 for severe disease (85.71, 83.99), ≥ 3 for ICU admission (86.90, 71.91), and ≥ 4 for intubation (87.61, 72.90). Hypertension, type 2 diabetes mellitus, hypothyroidism, history of ischaemic heart disease, and history of tuberculosis were independent risk factors for a high CXR index score, intubation, and ICU admission. CXR scores can be effectively used in low-resource settings for triaging patients, maintaining records, and disease prognostication.

Assessing the Severity of COVID-19 Lung Injury in Rheumatic Diseases Versus the General Population Using Deep Learning-Derived Chest Radiograph Scores.

ObjectiveCOVID‐19 patients with rheumatic disease have a higher risk of mechanical ventilation than the general population. We assessed lung involvement using a validated deep learning algorithm that extracts a quantitative measure of radiographic lung disease severity.MethodsWe performed a comparative cohort study of rheumatic disease patients with COVID‐19 and ≥1chest radiograph within ±2 weeks of COVID‐19 diagnosis and matched comparators. We used unadjusted and adjusted (for age, Charlson Comorbidity Index, and interstitial lung disease) quantile regression to compare the maximum Pulmonary X‐Ray Severity (PXS) score at the 10th‐90th percentiles between groups. We evaluated the association of severe PXS score (>9) with mechanical ventilation and death using Cox regression.ResultsWe identified 70 patients with rheumatic disease and 463 general population comparators. Maximum PXS scores were similar in the rheumatic disease patients and comparators at the 10th‐60th percentiles but significantly higher among rheumatic disease patients at the 70th‐90th percentiles (90th percentile score of 10.2 vs. 9.2, adjusted p=0.03). Rheumatic disease patients were more likely to have a PXS score >9 (20% vs. 11%, p=0.02), indicating severe pulmonary disease. Rheumatic disease patients with PXS scores >9 vs. ≤9 had higher risk of mechanical ventilation (HR 24.1 [95% CI: 6.7, 86.9]) and death (HR 8.2 [95% CI: 0.7, 90.4]).ConclusionsRheumatic disease patients with COVID‐19 had more severe radiographic lung involvement than comparators. Higher PXS scores were associated with mechanical ventilation and will be important for future studies leveraging big data to assess COVID‐19 outcomes in rheumatic disease patients.This article is protected by copyright. All rights reserved.

Improved Interobserver Reliability in Diagnosing and Staging Lesions of COVID-19 Between Radiologist and Emergency Medicine Physicians After an Online Course.

Background: Chest radiographs are the most basic and readily available imaging modality for visualizing the lungs and are potentially useful for describing the disease severity in patients showing respiratory symptoms in COVID-19 patients. The early diagnosis of COVID-19 features on radiography helps in triaging and starting treatment.Material and methods: Our study consisted of 145 radiographs, and these were reported by two radiologists, two emergency physicians and one intern working in the Emergency department. The scores given by them were correlated. A targeted short lecture for the scoring was imparted and after a sufficient latent period the scoring of chest radiographs was done again, and the scores correlated and compared.Results: We observed agreement between radiologists with emergency medicine physicians was “none to slight” to “fair,” before the dedicated online teaching course. Following the meeting, there was an increase in interobserver agreement in-between radiologists and between radiologists and emergency medicine physicians.Conclusions: We propose a focused online meeting, targeted at explaining radiological features of a specific pathology, in a pandemic situation like COVID, to our clinical counterparts in the emergency medicine department can help in increasing their interpretation skills. This can directly benefit triaging, admission/discharge and monitoring of the status of patients, in intensive care units and emergency medicine. This also helps in allaying the anxiety, while waiting for a final report from the Radiologist.

ASSOCIATION OF CHEST RADIOGRAPHIC BRIXIA SCORE AND IN-HOSPITAL MORTALITY AMONG FILIPINO PATIENTS WITH CONFIRMED COVID-19 AT A SINGLE MEDICAL CENTER

TYPE: Late Breaking Abstract TOPIC: Imaging PURPOSE: To investigate the association of chest radiographic severity Brixia score and in-hospital mortality among admitted Filipino adult COVID-19 confirmed patients. METHODS: We retrospectively reviewed 125 baseline chest x-rays of adult Filipino COVID-19 confirmed patients admitted at a private tertiary hospital in Batangas between March 2020 to March 2021. Patients’ demographic data and clinical outcome were obtained. The Brixia score for each baseline CXR was designated independently by two radiologists who were blinded from the patient’s outcome. Logistic regression was done with Brixia score to determine association with in-hospital mortality. RESULTS: A total of 99 patients (79.2%) recovered while 26 patients died (20.8%) during this period. The results showed that there was a statistically significant association of Brixia scores (p value = 2.68 x 10-5 , OR = 1.28) with in-hospital mortality. Likewise, age (p value = 0.000636, OR = 1.05), hypertension (p value= 0.01579, OR = 3.00) , immunocompromised state (p value = 0.0042926, OR = 11.23) and smoking history (p value = 0.01579, OR = 2.16) were also significantly associated with in-hospital mortality. The average Brixia score from both radiologists yielded an optimal cut-point of 8 for in-hospital mortality with an AUC of 0.7706. CONCLUSIONS: The findings of this study suggest that Brixia scores obtained from baseline CXR have a statistically significant association with in-hospital mortality among COVID-19 confirmed Filipino patients. CLINICAL IMPLICATIONS: The use of Brixia scoring system from Italy may help Filipino clinicians systematically report CXR of COVID-19 patients and may help identify patients at higher risk for in-hospital mortality upon admission. DISCLOSURE: No significant relationships. KEYWORD: Brixia score

COVID-19 pneumonia chest radiographic severity score: variability assessment among experienced and in-training radiologists and creation of a multireader composite score database for artificial intelligence algorithm development.

The purpose was to evaluate reader variability between experienced and in-training radiologists of COVID-19 pneumonia severity on chest radiograph (CXR), and to create a multireader database suitable for AI development. In this study, CXRs from polymerase chain reaction positive COVID-19 patients were reviewed. Six experienced cardiothoracic radiologists and two residents classified each CXR according to severity. One radiologist performed the classification twice to assess intraobserver variability. Severity classification was assessed using a 4-class system: normal (0), mild (1), moderate (2), and severe (3). A median severity score (Rad Med) for each CXR was determined for the six radiologists for development of a multireader database (XCOMS). Kendal Tau correlation and percentage of disagreement were calculated to assess variability. A total of 397 patients (1208 CXRs) were included (mean age, 60 years SD ± 1), 189 men). Interobserver variability between the radiologists ranges between 0.67 and 0.78. Compared to the Rad Med score, the radiologists show good correlation between 0.79-0.88. Residents show slightly lower interobserver agreement of 0.66 with each other and between 0.69 and 0.71 with experienced radiologists. Intraobserver agreement was high with a correlation coefficient of 0.77. In 220 (18%), 707 (59%), 259 (21%) and 22 (2%) CXRs there was a 0, 1, 2 or 3 class-difference. In 594 (50%) CXRs the median scores of the residents and the radiologists were similar, in 578 (48%) and 36 (3%) CXRs there was a 1 and 2 class-difference. Experienced and in-training radiologists demonstrate good inter- and intraobserver agreement in COVID-19 pneumonia severity classification. A higher percentage of disagreement was observed in moderate cases, which may affect training of AI algorithms. Most AI algorithms are trained on data labeled by a single expert. This study shows that for COVID-19 X-ray severity classification there is significant variability and disagreement between radiologist and between residents.

Relationship between SARS-CoV-2 antibody titer and the severity of COVID-19.

BackgroundIt remains unclear whether high titers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies aggravate clinical manifestations in patients or whether severe clinical manifestations result in high antibody titers. Thus, we investigated the cause–effect relationship between SARS-CoV-2 antibody titers and disease severity.MethodsWe prospectively enrolled patients admitted with the diagnosis of coronavirus disease-19 (COVID-19) from February 2020 to August 2020. We measured SARS-CoV-2 antibody titers, namely anti-receptor-binding domain (RBD) antibody and neutralizing antibody (NAb), from blood samples and calculated the chest radiograph (CXR) scores of the patients to evaluate the severity of COVID-19.ResultsOverall, 40 patients with COVID-19 were enrolled. Pneumonia was observed in more than half of the patients (25/40, 60%). SARS-CoV-2 antibody titers were higher in patients who were aged >60 years (anti-RBD antibodies, P = 0.003 and NAb, P = 0.009), presented with pneumonia (P = 0.006 and 0.007, respectively), and required oxygen therapy (P = 0.003 and 0.004, respectively) than in those who were not. CXR scores peaked (at 15–21 days after the onset of symptoms) statistically significantly earlier than SARS-CoV-2 antibody titers (at 22–30 days for NAb and at 31–70 days for anti-RBD antibody). There was a close correlation between the maximum CXR score and the maximum SAR-CoV-2 antibody titer.ConclusionsBased on the comparison of the peak time of SARS-CoV-2 antibody titers with the CXR score after symptom onset, we suggest that severe clinical manifestations result in high titers of SARS-CoV-2 antibodies.

Chest X-ray Severity Score as a Putative Predictor of Clinical Outcome in Hospitalized Patients: An Experience From a Vietnamese COVID-19 Field Hospital.

BackgroundThrough the coronavirus disease 2019 (COVID-19) pandemic, portable radiography was particularly useful for assessing and monitoring the COVID-19 disease in Vietnamese field hospitals. It provides a convenient and precise picture of the progression of the disease. The purpose of this study was to evaluate the predictive value of chest radiograph reporting systems (Brixia and total severity score (TSS)) and the National Early Warning Score (NEWS) clinical score in a group of hospitalized patients with COVID-19.MethodsThis retrospective cohort study used routinely collected clinical data from polymerase chain reaction (PCR)-positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients admitted to Field Hospital District 8, Ho Chi Minh City, Vietnam, from August 2021 to September 2021. The initial chest radiographs were scored based on the TSS and Brixia scoring systems to quantify the extent of lung involvement. After the chest radiograph score was reported, two residents calculated the rate of all-cause in-hospital mortality with the consultation of expert radiologists. In this study, NEWS2 scores on hospital admission were calculated. The gradient boosting machines (GBMs) and Shapley additive exPlanations (SHAP) were applied to access the important variable and improve the accuracy of mortality prediction. The adjusted odds ratio for predictor was presented by univariate analysis and multivariate analysis.ResultsThe chest X-rays (CXRs) at the admission of 273 patients (mean age 59 years +/-16, 42.1% were male) were scored. In the univariate analysis, age, vaccination status, previous disease, NEWS2, a saturation of peripheral oxygen (Sp02), the Brixia and TSS scores were significant predictors of mortality (p-value < 0.05). In multivariate analysis, there were statistically significant differences in mortality between age, Sp02, Brixia score, and patients with previous diseases were independent predictors of mortality and hospitalization.A gradient boosting machine was performed in the train data set, which showed that the best hyperparameters for predicting the mortality of patients are the Brixia score (exclude TSS score). In the top five predictors, an increase in Brixia, age, and BMI increased the logarithmic number of probability clarifying as death status. Although the TSS and Brixia scores evaluated chest imaging, the TSS score was not essential as the Brixia score (rank 6/11). It was clear that the BMI and NEWS2 score was positively correlated with the Brixia score, and age did not affect this correlation. Meanwhile, we did not find any trend between the TSS score versus BMI and NEWS2.ConclusionWhen integrated with the BMI and NEWS2 clinical classification systems, the severity score of COVID-19 chest radiographs, particularly the Brixia score, was an excellent predictor of all-cause in-hospital mortality.

COVID-19 in Kidney Transplant Recipient and Waitlist Patients: Implications of Chest Radiographic Severity Score.

Purpose:To evaluate the chest radiographic severity score (CXR-SS) for coronavirus disease 2019 (COVID-19) patients who are kidney transplant recipients compared with patients on the waitlist.Study Design and Methods:This retrospective cohort includes 78 kidney transplant recipients (50 men, mean age 59.9±11.9 y) and 59 kidney transplant waitlist patients (33 men, mean age 58.8±10.8 y) diagnosed with COVID-19 between March 15 and May 30, 2020 with reverse transcriptase-polymerase chain reaction. Patient chest radiographs were divided into 6 zones and examined for consolidation. Primary outcome was mortality. Secondary outcomes included hospital admission, intensive care unit (ICU) admission, and intubation. Predictors of our primary and secondary outcomes were identified by bivariate analysis and multivariate regression analysis.Results:No significant difference was found in CXR-SS between 2 groups (P=0.087). Transplant recipients had significantly higher rates of hospitalization (odds ratio, 6.8; 95% confidence interval: 1.7, 39.3; P<0.001), ICU admission (odds ratio, 6.5; 95% confidence interval [CI]: 1.8-35.9; P=0.002), intubation (odds ratio, 11; 95% CI: 2.4-96.9; P=0.001), and mortality (odds ratio, 17; 95% CI: 3.9-153.1; P<0.001). A higher CXR-SS was not predictive of mortality, intubation, or ICU admission. CXR-SS was associated with hospital admission overall (odds ratio, 1.613; 95% CI: 1.04-2.49; P=0.0314).Conclusion:The CXR-SS was not predictive of mortality, ICU admission or intubation in our population. Kidney transplant patients with COVID-19 had near universal hospital admission, more than one-third mortality and about a quarter were intubated and admitted to the ICU—all significantly worse outcomes than for patients on the transplant waitlist.

COVID-2019 Pneumonia: Severity and distribution of lung changes observed on the initial chest X-ray as an indicator of final outcomes.

ObjectivesThis study aimed to assess the correlation between the severity of the initial chest x-ray (CXR) abnormalities in patients with a confirmed diagnosis of COVID-19 and the final outcomes.MethodsThis retrospective study was conducted at the Royal Hospital, Oman between mid-March and May 2020 and included patients who had been admitted with a confirmed diagnosis of COVID-19 and had a final outcome. Serial CXRs were identified and examined for presence, extent, distribution and progression pattern of radiological abnormalities. Each lung field was divided into three zones on each CXR and a score was allocated for each zone (0 is normal and 1–4 is mild–severe). The scores for all six zones per CXR examination were summed to provide a cumulative chest radiographic score (range: 0–24).ResultsA total of 64 patients were included; the majority were male (89.1%) and the mean age was 50.22 ± 14.86 years. The initial CXR was abnormal in 60 patients (93.8%). The most common finding was ground glass opacity (n = 58, 96.7%) followed by consolidation (n = 50, 83.3%). Most patients had bilateral (n = 51, 85.0%), multifocal (n = 57, 95.0%) and mixed central and peripheral (n = 36, 60.0%) lung abnormalities. The median score of initial CXR for deceased patients was significantly higher than recovered patients (17 versus 11; P = 0.009). Five CXR evolution patterns were identified: type I (initial radiograph deteriorates then improves), type II (fluctuate), type III (static), type IV (progressive deterioration) and type V (progressive improvement).ConclusionA higher baseline CXR score is associated with higher mortality rate and poor prognosis in those with COVID-19 pneumonia.

Intubation and mortality prediction in hospitalized COVID-19 patients using a combination of convolutional neural network-based scoring of chest radiographs and clinical data.

Objective:To predict short-term outcomes in hospitalized COVID-19 patients using a model incorporating clinical variables with automated convolutional neural network (CNN) chest radiograph analysis.Methods:A retrospective single center study was performed on patients consecutively admitted with COVID-19 between March 14 and April 21 2020. Demographic, clinical and laboratory data were collected, and automated CNN scoring of the admission chest radiograph was performed. The two outcomes of disease progression were intubation or death within 7 days and death within 14 days following admission. Multiple imputation was performed for missing predictor variables and, for each imputed data set, a penalized logistic regression model was constructed to identify predictors and their functional relationship to each outcome. Cross-validated area under the characteristic (AUC) curves were estimated to quantify the discriminative ability of each model.Results:801 patients (median age 59; interquartile range 46–73 years, 469 men) were evaluated. 36 patients were deceased and 207 were intubated at 7 days and 65 were deceased at 14 days. Cross-validated AUC values for predictive models were 0.82 (95% CI, 0.79–0.86) for death or intubation within 7 days and 0.82 (0.78–0.87) for death within 14 days. Automated CNN chest radiograph score was an important variable in predicting both outcomes.Conclusion:Automated CNN chest radiograph analysis, in combination with clinical variables, predicts short-term intubation and death in patients hospitalized for COVID-19 infection. Chest radiograph scoring of more severe disease was associated with a greater probability of adverse short-term outcome.Advances in knowledge:Model-based predictions of intubation and death in COVID-19 can be performed with high discriminative performance using admission clinical data and convolutional neural network-based scoring of chest radiograph severity.

Chest radiographic score and lactate dehydrogenase are independent risk factors linked to mortality in Middle East Respiratory Syndrome Coronavirus (MERS-CoV) patients

BackgroundDespite the dominance of Covid-19 in the current situation, MERS-CoV is found infrequently in the Middle East. When coupled with the chest radiographic score, serum biochemical parameters may be utilized to assess serum biochemical changes in individuals with different degrees of MERS-CoV infection and to predict death. The purpose of this study was to examine the association between increased LDH levels and severe MERS-CoV outcomes utilizing ventilation days and an elevated chest radiographic score.ResultsFifty-seven patients were included in the retrospective cohort. The mean age was 44.9 ± 13.5 years, while the range was between 12 and 73 years. With an average age of 53.3 ± 16.5 years, 18 of 57 (31.6%) patients were classified as deceased. The deceased group showed a substantially greater amount of LDH than the recovery group (280.18 ± 150.79 vs. 1241.72 ± 1327.77, p = 0.007). A cut-off value of > 512 LDH was established with a C-statistic of 0.96 (95% CI 0.92–1.00) and was 94% sensitive and 93% specific for mortality. Multivariate cox regression analysis revealed that loge (LDH) (adjusted HR: 9.91, 95% CI: 2.44–40.3, p = 0.001) and chest radiographic score (adjusted HR: 1.24, 95% CI: 1.05–1.47, p = 0.01) were risk factors for mortality, whereas ventilation days were a protective factor (adjusted HR: 0.84, 95% CI: 0.76–0.93, p = 0.001).ConclusionAccording to our results, blood LDH levels of > 512 had a 94% sensitivity and 93% specificity for predicting in-hospital mortality in patients infected with MERS-CoV. The chest radiographic score of 11.34 ± 5.4 was the risk factor for the mortality (adjusted Hazard ratio HR: 1.24, 95% CI: 1.05–1.47, p = 0.01). Thus, threshold may aid in the identification of individuals with MERS-CoV infection who die in hospital.

Covid-19 infection in pregnant women in Dubai: a case-control study

BackgroundWhilst the impact of Covid-19 infection in pregnant women has been examined, there is a scarcity of data on pregnant women in the Middle East. Thus, the aim of this study was to examine the impact of Covid-19 infection on pregnant women in the United Arab Emirates population.MethodsA case-control study was carried out to compare the clinical course and outcome of pregnancy in 79 pregnant women with Covid-19 and 85 non-pregnant women with Covid-19 admitted to Latifa Hospital in Dubai between March and June 2020.ResultsAlthough Pregnant women presented with fewer symptoms such as fever, cough, sore throat, and shortness of breath compared to non-pregnant women; yet they ran a much more severe course of illness. On admission, 12/79 (15.2%) Vs 2/85 (2.4%) had a chest radiograph score [on a scale 1-6] of ≥3 (p-value = 0.0039). On discharge, 6/79 (7.6%) Vs 1/85 (1.2%) had a score ≥3 (p-value = 0.0438). They also had much higher levels of laboratory indicators of severity with values above reference ranges for C-Reactive Protein [(28 (38.3%) Vs 13 (17.6%)] with p < 0.004; and for D-dimer [32 (50.8%) Vs 3(6%)]; with p < 0.001. They required more ICU admissions: 10/79 (12.6%) Vs 1/85 (1.2%) with p=0.0036; and suffered more complications: 9/79 (11.4%) Vs 1/85 (1.2%) with p=0.0066; of Covid-19 infection, particularly in late pregnancy.ConclusionsPregnant women presented with fewer Covid-19 symptoms but ran a much more severe course of illness compared to non-pregnant women with the disease. They had worse chest radiograph scores and much higher levels of laboratory indicators of disease severity. They had more ICU admissions and suffered more complications of Covid-19 infection, such as risk for miscarriage and preterm deliveries. Pregnancy with Covid-19 infection, could, therefore, be categorised as high-risk pregnancy and requires management by an obstetric and medical multidisciplinary team.

Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19.

Background Radiographic severity may help predict patient deterioration and outcomes from COVID-19 pneumonia.Purpose To assess the reliability and reproducibility of three chest radiograph reporting systems (radiographic assessment of lung edema [RALE], Brixia, and percentage opacification) in patients with proven SARS-CoV-2 infection and examine the ability of these scores to predict adverse outcomes both alone and in conjunction with two clinical scoring systems, National Early Warning Score 2 (NEWS2) and International Severe Acute Respiratory and Emerging Infection Consortium: Coronavirus Clinical Characterization Consortium (ISARIC-4C) mortality.Materials and Methods This retrospective cohort study used routinely collected clinical data of patients with polymerase chain reaction–positive SARS-CoV-2 infection admitted to a single center from February 2020 through July 2020. Initial chest radiographs were scored for RALE, Brixia, and percentage opacification by one of three radiologists. Intra- and interreader agreement were assessed with intraclass correlation coefficients. The rate of admission to the intensive care unit (ICU) or death up to 60 days after scored chest radiograph was estimated. NEWS2 and ISARIC-4C mortality at hospital admission were calculated. Daily risk for admission to ICU or death was modeled with Cox proportional hazards models that incorporated the chest radiograph scores adjusted for NEWS2 or ISARIC-4C mortality.Results Admission chest radiographs of 50 patients (mean age, 74 years ± 16 [standard deviation]; 28 men) were scored by all three radiologists, with good interreader reliability for all scores, as follows: intraclass correlation coefficients were 0.87 for RALE (95% CI: 0.80, 0.92), 0.86 for Brixia (95% CI: 0.76, 0.92), and 0.72 for percentage opacification (95% CI: 0.48, 0.85). Of 751 patients with a chest radiograph, those with greater than 75% opacification had a median time to ICU admission or death of just 1–2 days. Among 628 patients for whom data were available (median age, 76 years [interquartile range, 61–84 years]; 344 men), opacification of 51%–75% increased risk for ICU admission or death by twofold (hazard ratio, 2.2; 95% CI: 1.6, 2.8), and opacification greater than 75% increased ICU risk by fourfold (hazard ratio, 4.0; 95% CI: 3.4, 4.7) compared with opacification of 0%–25%, when adjusted for NEWS2 score.Conclusion Brixia, radiographic assessment of lung edema, and percentage opacification scores all reliably helped predict adverse outcomes in SARS-CoV-2 infection.© RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Little in this issue.

The chest radiographic scoring system in initial diagnosis of COVID-19: Is a radiologist needed?

Lung imaging, next to a polymerase chain reaction (PCR) test, is a key diagnostic tool in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The degree of abnormalities correlates with clinical outcome. Imaging of the lungs using chest radiography (CXR) at the peak of a pandemic is considered a basic diagnostic tool at the triage stage. The CXR images are less characteristic than computed tomography (CT) and should be interpreted with a combination of clinical findings. Comparison of the usefulness of 2 CXR severity scores to evaluate the presence/severity of inflammation in the course of COVID-19 and the possibility of a non-radiologist to interpret the image independently. Retrospective analysis of the medical records of 152 consecutive patients (aged 19-96, 73 men), infected with SARS-CoV-2, confirmed using real-time PCR (RT-PCR). Five-point and twelve-point CXR severity scoring systems were used (independently by a radiologist and a referring physician) to assess the severity of inflammation. In 77 of 152 cases, the CXR revealed features of inflammation. Bilateral abnormalities were found in 48/77 (62.3%) cases. Statistically, the lower lobes were involved more often than the upper ones (p < 0.001) and the left lobe more often than the right one (p < 0.001). The intensity of the abnormalities using both scales correlated with the persistence of symptoms (p = 0.0133 and p = 0.0403). A positive and statistically significant correlation was found between both scales and dyspnea, decreased oxygen saturation, elevated C-reactive protein (CRP), ferritin, D-dimer, lactate dehydrogenase, and alanine aminotransferase activity. The interobserver agreement analysis did not show a statistically significant difference in the CXR severity score using the five-point (B = 0.8345, kappa = 0.82; p = 0.1480) or the twelve-point scale (B = 0.8219, kappa = 0.77; p = 0.0502). The CXR severity score is a useful tool to assess the inflammation in the initial diagnosis of coronavirus disease 2019 (COVID-19). Quantifying lung abnormalities accurately may be performed by a referring physician. Both CXR severity scales correlate well with clinical parameters.

A Novel Severity Scoring Derived from Chest Radiographic Findings in COVID 19 Patients Admitted to a COVID Care University Hospital in India

Coronavirus (COVID 19) disease predominantly affects the Respiratory system and cause by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2). It enters into the host cells via angiotensin-converting enzyme-2 (ACE-2), a part of the renin-angiotensin system (RAS) found in the epithelium of the nasal, lungs.&#x0D; Aim: Chest Radiographic findings in COVID-19 patients detected for COVID care. Applying the novel chest radiographic scoring in disease-spread patients is admitted to the COVID care center and its correlation with blood oxygen saturation (SpO2) and clinical severity.&#x0D; Objective: 1) To apply the novel chest radiographic scoring in patients of COVID 19 infection are admitted to our Covid Care Centre and&#x0D; 2) To apply its correlation with blood oxygen saturation (SpO2) and clinical severity.&#x0D; Results: 1) We found a moderate negative correlation between the chest radiographic score and SpO2. 2) Weak positive correlation between Clinical grading and CxR score.&#x0D; Conclusion: Chest radiographic score taking into account the nature of opacities and extent is useful in classifying the patients into mild-moderate, severe, and critical grades. Take-home Message: A chest radiograph can be used as a baseline radiological investigation in COVID 19 patients as it can help to triage them according to the severity and treat them accordingly.

Airway Pressure Release Ventilation Mode Improves Circulatory and Respiratory Function in Patients After Cardiopulmonary Bypass, a Randomized Trial.

ImportancePostoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality, and resource utilization in cardiac surgery patients.ObjectivesTo investigate the effects of airway pressure release ventilation (APRV) on respiration and hemodynamics in post cardiac surgery patients.Main Outcomes and MeasuresA single-center randomized control trial was performed. In total, 138 patients undergoing cardiopulmonary bypass were prospectively screened. Ultimately 39 patients met the inclusion criteria and were randomized into two groups: 19 patients were managed with pressure control ventilation (PCV) and 20 patients were managed with APRV. Respiratory mechanics after 4 h, hemodynamics within the first day, and Chest radiograph score (CRS) and blood gasses within the first three days were recorded and compared.ResultsA higher cardiac index (3.1 ± 0.7 vs. 2.8 ± 0.8 L⋅min–1⋅m2; p < 0.05), and shock volume index (35.4 ± 9.2 vs. 33.1 ± 9.7 ml m–2; p < 0.05) were also observed in the APRV group after 4 h as well as within the first day (p < 0.05). Compared to the PCV group, the PaO2/FiO2 was significantly higher after 4 h in patients of APRV group (340 ± 97 vs. 301 ± 82, p < 0.05) and within the first three days (p < 0.05) in the APRV group. CRS revealed less overall lung injury in the APRV group (p < 0.001). The duration of mechanical ventilation and ICU length of stay were not significantly (p = 0.248 and 0.424, respectively).Conclusions and RelevanceCompared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients.

Role of chest radiograph in MERS-Cov pneumonia: a single tertiary referral center experience in the United Arab Emirates

BackgroundThe Middle East respiratory syndrome coronavirus (MERS-Cov) continues to be a source of concern due to intermittent outbreaks. Serial chest radiographic changes in MERS-Cov patients were analyzed for various variables that could be compared to the patients’ final outcomes in a cluster of MERS-Cov patients and to identify a predictor of mortality in the United Arab Emirates.ResultsA total of 44 MERS-Cov cases were reviewed. The mean age of the patients was 43.7 ± 14.7 years. The chest radiograph was abnormal in 14/44 (31.8%). The commonest radiology features include ground-glass opacities (seven of 14, 50%), ground-glass and consolidation (seven of 14, 50%), pleural effusion (eight of 14, 57.1%), and air bronchogram (three of 14, 21.4%). The mortality rate was 13.6% (six of 44); the deceased group (6 of 44, 13.6%) was associated with significantly higher incidence of mechanical ventilation (p < 0.001), pleural effusion (p < 0.001), chest radiographic score (8.90 ± 6.31, p < 0.001), and type 4 radiographic progression of disease (p < 0.001). A chest radiographic score at presentation was seen to be an independent and strong predictor of mortality (OR [95% confidence interval] 3.20 [1.35, 7.61]). The Cohen κ coefficient for the interobserver agreement was k = 0.89 (p = 0.001).ConclusionThe chest radiographic score, associated with a higher degree of disease progression (type 4), particularly in patients with old age or with comorbidity, may indicate a poorer prognosis in MERS-Cov infection, necessitating intensive care unit management or predicting impending death.

Poor Outcomes of COVID-19 in Lung Transplant Recipients. Cohort Study in a Single Center

PurposeThe world SARS-CoV-2 pandemic has affected global health, including the health of lung transplant recipients. There is very little data reported on the outcomes of SARS-CoV-2 on this gruop of patientsMethodsRetrospective cohort study approved of all LTx recipients with symptoms consistent with COVID-19 investigated with naso-pharyngeal swabs and reverse PCR for SARS-COV-2. Postive test for SARS-COV-2 Inserted to our cohort and investigated their files. We also conducted pooled analysis of published cases of covid 19 cases of lung transplant recipientsResultsWe identified eleven cases of COVID-19 among a cohort of 348 LTx recipients. All but two patients were hospitalized. Seven patients required intensive care and six died (55% mortality). Non-survivors had lower baseline FEV1 than survivors and worse and/or deteriorating chest radiographic scores during admission. No effect of medical therapy including steroids and remdesivir could be determined. This mortality rate compared poorly general hospitalized COVID-19 patients at our institution (13%) and national mortality rate of 0.3% in the general population. Incidence of COVID-19 was similar to the general population (0.3%). In a pooled analysis of published cases, we determined mortality of 28% across different reports of lung transplant patients with COVID-19.ConclusionCOVID-19 disease is very severe in lung transplant recipients. In the absence of effective therapy and vaccination, transplant physicians should concentrate their efforts on prevention of disease and encourage meticulous preventative behavior by recipients under their care.