Chest X-ray Scores Research Articles

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.

COVID-19 disease characteristics in different pediatric age groups.

Little is known about the COVID-19 disease characteristics and differences between different pediatric age groups. This study aimed to investigate the disease characteristics according to age groups. We conducted a retrospective, single-center study of pediatric COVID-19 in a tertiary care hospital in Turkey. The patients were divided into three groups: 15 days-24 months old (Group 1), 25-144 months old (Group 2), and 145-210 months old (Group 3) according to age. A total of 139 pediatric patients with COVID-19 were examined. Twenty-nine patients (20.9%) were in Group 1, 52 (37.4%) were in Group 2, 58 (41.7%) were in Group 3. Thirty-nine patients (28.1%) were hospitalized. The most common symptoms were cough (55.4%) and fever (51.8%). The median chest X-ray (CXR) score of hospitalized patients was 1 (min 0-max 7), and the median CXR score of outpatients was 1 (min 0-max 6). Fever was significantly more frequent in Group 1, and chest pain was more frequent in Group 3. Group 1 had significantly higher WBC, lymphocyte, thrombocyte counts, AST, LDH, D-dimer, and Troponin T levels but lower hemoglobin, total protein, and albumin levels. The treatment included antibiotics, oseltamivir, hydroxychloroquine, and supportive therapy. Only one patient (0.7%) received non-invasive mechanical ventilatory support. As we know the clinical course of COVID-19 in children is less severe than in adults. We also found significant differences in both clinical and laboratory findings between different pediatric age groups which supports the theory that disease pathogenesis is highly variable according to age.

Correlation of Chest Radiological Findings with Biochemical Markers on Oxygen Requirement in COVID-19 Patients: A Retrospective Analysis

Background: The study is to correlate Chest X-ray scoring with the laboratory markers and to determine the oxygen requirement in COVID-19 patients. Methodology: We conducted a retrospective study in COVID confirmed patients in the age group of 18 to 80 years admitted in our health care system. At the time of admission within 24 hours, chest X-ray and blood investigations like complete blood count, C-reactive protein, Lactate Dehydrogenase (LDH), d-dimers, serum ferritin were performed in all the patients. Patients data including his oxygen requirement was collected by electronic medical records. Brixia scoring system was employed to account for the extent and density of airspace opacification. The scoring of the Chest X-ray was correlated to the various blood test. Result: One hundred nine COVID confirmed cases were included in our study. There was a statistically significant correlation between Chest X-ray and age with p = 0.008; chest X-ray and d-dimers with p=0.004. Also patients requiring high oxygen therapy had significantly higher chest X-ray scores (p=0.001) Conclusion: Patient having increased oxygen requirement were found to have higher N/L Ratio, D-dimer and LDH values. Chest X-ray scoring is highly correlated with laboratory findings and disease severity and might be beneficial to speed up the diagnostic workflow in symptomatic patients.

Uniportal thoracoscopic decortication: start away from empyema approach

Aim: Video-assisted thoracoscopic surgery (VATS) is now a gold standard in treating early-stage empyema, while much debate still exists considering the effectiveness of this approach for late-stage empyema. Most concerns arise from the crowded rib cage, narrow working space, and ability to free trapped lungs quickly, mainly if uniportal VATS is used. However, unlike uniportal VATS lobectomy, there is no consensus about standard steps for uniportal VATS decortication to ensure smooth and effective surgery. We try to offer standard, easy-to-replicate steps for this approach to evaluate the efficacy and safety of the “start away from empyema” approach for uniportal VATS decortication in the management of stage II and III empyema. Methods: A prospective case series study has been conducted on 25 patients. All patients with stage II and III empyema were admitted to the Cardiothoracic Surgery Department between October 2017 and March 2020. VATS procedure was done under general anesthesia by a double-lumen tube for selective ventilation. Demographic data, preoperative diagnosis, intraoperative findings, hospital stay, and complications were recorded. Results: Twenty-five patients were enrolled in this study with a median age of 35 years. The duration of illness ranged between 14 and 60 days, with a median (IQR) of 25 (17) days. In (88%) of the patients, there was a successful outcome defined as a near-complete resolution on Chest X-ray (scoring of 3 or 4) and chest US (scoring of 2 or 3). Only three (12%) patients had a partially successful outcome. All patients with partial success suffered from infection associated with malignant effusion. Conclusion: “Start away from empyema” approach for uniportal VATS decortication in stage II and III empyema could be safe and effective in treating loculated nonmalignant pleural effusion.

Chest X-Ray Scoring System in COVID-19 Pneumonia: An Added Value in the Evaluation of the Disease Severity

Objectives: To analyze the added value of a new CXR scoring system in the evaluation of the COVID-19 pneumonia severity. Methods: This retrospective study included, from March to April 2020, 169 (132M/37F) hospitalized COVID-19 patients, mean age 65.6±10.8 years; 57 had low-pressure ventilation (Group A), 50 positive-pressure ventilation (Group B) and 62 invasive ventilation (Group C). Two radiologists in consensus evaluated the CXRs using an 18-points scoring system. CXR scores were compared in each Group and among the three Groups. Then in each Group CXR scores were correlated with Pa02/Fi02 and, in Group C, with Simplified Acute Physiology Score (SAPS). Non-parametric tests were used. Results: In Group A the median score at admission was 8 [Interquartile range (IR) 7-9] and the median of the highest scores was 9 [IR 8-10](p=0.0738). Median scores at admission and before the start of the ventilation (pre-ventilation) are resulted, in Group B, 10 [IR 8-10] and 11 [IR 10-14](p<0.0001) and, in Group C, 10 [IR 8-11] and 12 [IR 11-13](p<0.0001). In Group A the CXR scores at admission were lower than in Group C (p=0.0257), and the highest scores were lower than the pre-ventilation ones of Groups B (p=0.0018) and C (p=0.0001). The CXR scores correlated negatively with Pa02/Fi02 and positively with SAPS. Conclusion: CXR scoring system could be an added value in the evaluation of COVID-19 pneumonia severity. With lowpressure ventilation, the CXR scores were lower than with positive-pressure and invasive ventilation. Furthermore, CXR scores showed negative correlation with Pa02/Fi02 and positive with SAPS. Implications for practice: This new CXR scoring system could be a useful diagnostic tool to quantify the COVID-19 pneumonia severity and to guide to choice of the correct ventilation support. Keywords: CXR, Chest X-ray, Coronavirus Disease, Scoring System

Coronavirus Disease 2019 Outbreak: Use of a Chest X-ray Scoring System and Evaluation of the Radiologic Findings

Coronavirus Disease 2019 Outbreak: Use of a Chest X-ray Scoring System and Evaluation of the Radiologic Findings

Modified Brixia chest X-ray severity scoring system and correlation with intubation, non-invasive ventilation and death in a hospitalised COVID-19 cohort.

There are few existing severity scoring systems in the literature, and no formally widely accepted chest X-ray template for reporting COVID-19 infection. We aimed to modify the chest X-ray COVID-19 severity scoring system from the Brixia scoring system with placement of more emphasis on consolidation and to assess if the scoring tool could help predict intubation. A severity chest X-ray scoring system was modified from the Brixia scoring system. PCR positive COVID-19 positive patient's chest X-rays admitted to our hospital over 3 months were reviewed and correlated with; non-invasive ventilation, intubation and death. An analysis was performed using a receiver operating curve to predict intubation from all admission chest X-rays. The median score of all 325 admission chest X-rays was 3 (Interquartile range (IQR) 0-6.5). The median score of admission chest X-rays of those who did not require ICU admission and survived was 1.5 (IQR 0-5); and 9 (IQR 4.75-12) was median admission score of those requiring intubation. The median scores of the pre-intubation ICU chest X-rays was 11.5 (IQR 9-14.125), this increased from a median admission chest X-ray score for this group of 9 (P-value < 0.01). A cut-off score of 6 had a sensitivity of 77% and specificity of 73% in predicting the need for intubation. Higher chest X-ray severity scores are associated with intubation, need for non-invasive ventilation and death. This tool may also be helpful in predicting intubation.

Systemic Inflammation and Complement Activation Parameters Predict Clinical Outcome of Severe SARS-CoV-2 Infections.

Overactivation of the complement system has been characterized in severe COVID-19 cases. Complement components are known to trigger NETosis via the coagulation cascade and have also been reported in human tracheobronchial epithelial cells. In this longitudinal study, we investigated systemic and local complement activation and NETosis in COVID-19 patients that underwent mechanical ventilation. Results confirmed significantly higher baseline levels of serum C5a (24.5 ± 39.0 ng/mL) and TCC (11.03 ± 8.52 µg/mL) in patients compared to healthy controls (p < 0.01 and p < 0.0001, respectively). Furthermore, systemic NETosis was significantly augmented in patients (5.87 (±3.71) × 106 neutrophils/mL) compared to healthy controls (0.82 (±0.74) × 106 neutrophils/mL) (p < 0.0001). In tracheal fluid, baseline TCC levels but not C5a and NETosis, were significantly higher in patients. Kinetic studies of systemic complement activation revealed markedly higher levels of TCC and CRP in nonsurvivors compared to survivors. In contrast, kinetic studies showed decreased local NETosis in tracheal fluid but comparable local complement activation in nonsurvivors compared to survivors. Systemic TCC and NETosis were significantly correlated with inflammation and coagulation markers. We propose that a ratio comprising systemic inflammation, complement activation, and chest X-ray score could be rendered as a predictive parameter of patient outcome in severe SARS-CoV-2 infections.

Major Neutrophil-Derived Soluble Mediators Associate With Baseline Lung Pathology and Post-Treatment Recovery in Tuberculosis Patients.

BackgroundThe inflammatory response to Mycobacterium tuberculosis results in variable degrees of lung pathology during active TB (ATB) with central involvement of neutrophils. Little is known about neutrophil-derived mediators and their role in disease severity at baseline and recovery upon TB treatment initiation.Methods107 adults with confirmed pulmonary TB were categorised based on lung pathology at baseline and following successful therapy using chest X-ray scores (Ralph scores) and GeneXpert bacterial load (Ct values). Plasma, sputum, and antigen-stimulated levels of MMP1, MMP3, MMP8, MMP9, MPO, S100A8/9, IL8, IL10, IL12/23(p40), GM-CSF, IFNγ, and TNF were analysed using multiplex cytokine arrays.ResultsAt baseline, neutrophil counts correlated with plasma levels of MMP8 (rho = 0.45, p = 2.80E−06), S100A8 (rho = 0.52, p = 3.00E−08) and GM-CSF (rho = 0.43, p = 7.90E−06). Levels of MMP8 (p = 3.00E−03), MMP1 (p = 1.40E−02), S100A8 (p = 1.80E−02) and IL12/23(p40) (p = 1.00E−02) were associated with severe lung damage, while sputum MPO levels were directly linked to lung damage (p = 1.80E−03), Mtb load (p = 2.10E−02) and lung recovery (p = 2.40E−02). Six months of TB therapy significantly decreased levels of major neutrophil-derived pro-inflammatory mediators: MMP1 (p = 4.90E−12 and p = 2.20E−07), MMP8 (p = 3.40E−14 and p = 1.30E−05) and MMP9 (p = 1.60E−04 and p = 1.50E−03) in plasma and sputum, respectively. Interestingly, following H37Rv whole cell lysate stimulation, S100A8 (p = 2.80E−02), MMP9 (p = 3.60E−02) and MPO (p = 9.10E−03) levels at month 6 were significantly higher compared to baseline. Sputum MMP1 (p = 1.50E−03), MMP3 (p = 7.58E−04), MMP9 (p = 2.60E−02) and TNF (p = 3.80E−02) levels were lower at month 6 compared to baseline in patients with good lung recovery.ConclusionIn this study, patients with severe lung pathology at baseline and persistent lung damage after treatment were associated with higher plasma and sputum levels of major pro-inflammatory neutrophil-derived mediators. Interestingly, low sputum MPO levels were associated with severe lung damage, higher Mtb burden and low recovery. Our data suggest that therapeutic agents which target these mediators should be considered for future studies on biomarkers and host-directed therapeutic approaches against TB-related lung pathology and/or lung recovery.

Utility of Lung Ultrasound in the Estimation of Extravascular Lung Water in a Pediatric Population—A Prospective Observational Study

Lung ultrasound (LUS) is a promising bedside modality for the estimation of extravascular lung water index (EVLWI), but has not been validated against objective measures in children. This study aimed to investigate the correlation of LUS B-line scoring with EVLWI, thresholds indicating elevated EVLWI, and its outcome following pediatric cardiac surgery. Prospective observational study. Cardiothoracic surgical intensive care unit in a tertiary care teaching hospital. Children younger than 12 years undergoing elective complete surgical correction of cyanotic or acyanotic congenital heart disease (Aristotle score ≤9), excluding neonates, those weighing <3.5 kg, and those with thoracic deformities, pulmonary pathology, and hemodynamic instability. Extravascular lung water index measurement by transpulmonary thermodilution, along with concurrent LUS B-line and Chest-X ray (CXR) scoring. LUS B-line score had a moderate correlation with EVLWI (Pearson's correlation coefficient 0.57; 95% CI 0.44-0.69). LUS B-line scores showed acceptable discrimination only for higher thresholds of EVLWI (sensitivity 82% and 79%, respectively, for EVLWI >20 mL/kg v sensitivity and specificity 57% and 80% for EVLWI >10 mL/kg). Age, body surface area, vasoactive-inotropic score (VIS), chest X-ray score, and EVLWI but not LUS B-line score were significant predictors for duration of mechanical ventilation in this cohort. LUS B-line scoring has limited utility in semiquantitative estimation of EVLWI at lower thresholds of EVLWI in pediatric cardiac surgical patients. It may have better discrimination and acceptable sensitivity and specificity at higher thresholds of EVLWI. Contrasting with multiple reports of clinical utility, these results call for wider evaluation of LUS and its clinical modifiers like age, pathology, and pretest probability in estimation of EVLWI.

Early prediction of in-hospital death of COVID-19 patients: a machine-learning model based on age, blood analyses, and chest x-ray score.

An early-warning model to predict in-hospital mortality on admission of COVID-19 patients at an emergency department (ED) was developed and validated using a machine-learning model. In total, 2782 patients were enrolled between March 2020 and December 2020, including 2106 patients (first wave) and 676 patients (second wave) in the COVID-19 outbreak in Italy. The first-wave patients were divided into two groups with 1474 patients used to train the model, and 632 to validate it. The 676 patients in the second wave were used to test the model. Age, 17 blood analytes, and Brescia chest X-ray score were the variables processed using a random forests classification algorithm to build and validate the model. Receiver operating characteristic (ROC) analysis was used to assess the model performances. A web-based death-risk calculator was implemented and integrated within the Laboratory Information System of the hospital. The final score was constructed by age (the most powerful predictor), blood analytes (the strongest predictors were lactate dehydrogenase, D-dimer, neutrophil/lymphocyte ratio, C-reactive protein, lymphocyte %, ferritin std, and monocyte %), and Brescia chest X-ray score (https://bdbiomed.shinyapps.io/covid19score/). The areas under the ROC curve obtained for the three groups (training, validating, and testing) were 0.98, 0.83, and 0.78, respectively. The model predicts in-hospital mortality on the basis of data that can be obtained in a short time, directly at the ED on admission. It functions as a web-based calculator, providing a risk score which is easy to interpret. It can be used in the triage process to support the decision on patient allocation.

Mortality Reduction in ICU-Admitted COVID-19 Patients in Suriname after Treatment with Convalescent Plasma Acquired Via Gravity Filtration

Introduction: Although convalescent plasma (CP) treatment is a potential therapeutic option for patients with COVID-19, there is a paucity of data from intensive care unit (ICU) patients with COVID-19 in low-resource settings, such as Suriname. CP was produced by a novel gravity-based filtration method. Methods: In an open-label, multi-center, non-randomized prospective clinical trial, patients with severe or life- threatening COVID-19 symptoms (n=28) with CP treatment were compared with standard treatment alone (n=50). A pre-planned interim analysis is reported. The primary endpoint was a 28-day ICU mortality. Secondary endpoints were changes two days after treatment initiation in pulmonary oxygen exchange capacity (PF ratio) and chest x-ray (CXR) score. Results: Mortality occurred in 18% (CP: 5/28) vs. 36% (Control:18/50). CP treatment of severe COVID-19 resulted in a higher probability of survival, with a hazard ratio (HR) of 0.22 (95% CI, 0.074-0.067), correcting for age, the presence of diabetes and COVID-19 severity. In the severe group, CP resulted in an improved CXR score (P = 0.0013) and increase in PF ratio (P = 0.011) as compared to standard therapy. The gravity-based plasmapheresis method used for CP production was well-tolerated and no adverse events were observed in the donors. Discussion: CP therapy in combination with standard treatment resulted in 78% reduction of 28-day ICU mortality (HR = 0.22) compared to standard treatment alone. Both CXR-score and PF ratio changes represent effective indicators for the treatment effect of CP after two days. The novel CP production method was effective and represents a practical solution for Low- and middle-income countries to produce CP.

Haematological and radiological-based prognostic markers of COVID-19

BackgroundAcute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged in 2019 and caused a global pandemic in 2020, manifesting in the coronavirus disease 2019 (COVID-19). The majority of patients exhibit a mild form of the disease with no major complications; however, moderate to severe and fatal cases are of public health concerns. Predicting the potential prognosis of COVID-19 could assist healthcare workers in managing cases and controlling the pandemic in an effective way. Therefore, the objectives of the study were to search for biomarkers associated with COVID-19 mortality and predictors of the overall survival (OS). MethodsHere, clinical data of 6026 adult COVID-19 patients admitted to two large centers in Saudi Arabia (Riyadh and Hafar Al-Batin cities) between April and June 2020 were retrospectively analysed. ResultsMore than 23% of the study subjects with available data have died, enabling the prediction of mortality in our cohort. Markers that were significantly associated with mortality in this study were older age, increased d-dimer in the blood, higher counts of WBCs, higher percentage of neutrophil, and a higher chest X-ray (CXR) score. The CXR scores were also positively associated with age, d-dimer, WBC count, and percentage of neutrophil. This supports the utility of CXR scores in the absence of blood testing. Predicting mortality based on Ct values of RT-PCR was not successful, necessitating a more quantitative RT-PCR to determine virus quantity in samples. Our work has also identified age, d-dimer concentration, leukocyte parameters and CXR score to be prognostic markers of the OS of COVID-19 patients. ConclusionOverall, this retrospective study on hospitalised cohort of COVID-19 patients presents that age, haematological, and radiological data at the time of diagnosis are of value and could be used to guide better clinical management of COVID-19 patients.

CHEST X RAY SCORE AND CLINICAL SEVERITY IN COVID-19 PATIENTS

INTRODUCTION: Various chest X-ray scoring systems have been discovered and are employed to correlate with clinical severity, outcome and progression of diseases. With, the coronavirus outbreak, few chest radiograph classication were formulated, like the BSTI classication and the Brixia chest X-ray score. Brixia CXR scoring is used for assessing the clinical severity and outcome of COVID-19. This study aims to compare the Brixia CXR score with clinical severity of COVID-19 patients. MATERIAL&amp; METHODS:This was a retrospective study in which medical records of patients aged 18 years or above, who tested for RTPCR or st st Rapid Antigen Test (RAT) for COVID positive from 1 February 2021 to 31 July 2021 (6 months) were taken. These subjects were stratied into mild, moderate and severe patients according to the ICMR guidelines. Chest X Rays were obtained and lesions were classied according to Brixia scoring system. RESULTS: Out of these 375 patients, 123 (32.8%) were female and 252 (67.2%) were male subjects. The average brixia score was 11.12. Average Brixia CXR score for mild, moderate and severe diseased subjects were 5.23, 11.20, and 14.43 respectively. DISCUSSION:The extent of chest x-ray involvement is proportional to the clinical severity of the patient. Although, a perplexing nding was that the average Brixia score of the female subjects were slightly higher than their male counterparts in the same clinical groups. CONCLUSION: Brixia CXR score correlates well with the clinical severity of the COVID-19.

Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19.

Background. The purpose of this study was to evaluate the prognostic impact of chest X-ray (CXR) score, frailty, and clinical and laboratory data on in-hospital mortality of hospitalized older patients with COVID-19. Methods. This retrospective study included 122 patients 65 years or older with positive reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and with availability to CXRs on admission. The primary outcome of the study was in-hospital mortality. Statistical analysis was conducted using Cox regression. The predictive ability of the CXR score was compared with the Clinical Frailty Scale (CFS) and fever data using Area Under the Curve (AUC) and net reclassification improvement (NRI) statistics. Results. Of 122 patients, 67 died during hospital stay (54.9%). The CXR score (HR: 1.16, 95% CI, 1.04–1.28), CFS (HR: 1.27; 95% CI, 1.09–1.47), and presence of fever (HR: 1.75; 95% CI, 1.03–2.97) were significant predictors of in-hospital mortality. The addition of both the CFS and presence of fever to the CXR score significantly improved the prediction of in-hospital mortality (NRI, 0.460; 95% CI, 0.102 to 0.888; AUC difference: 0.117; 95% CI, 0.041 to 0.192, p = 0.003). Conclusions. CXR score, CFS, and presence of fever were the main predictors of in-hospital mortality in our cohort of hospitalized older patients with COVID-19. Adding frailty and presence of fever to the CXR score statistically improved predictive accuracy compared to single risk factors.

Chest x-ray scoring as a predictor of COVID-19 disease; correlation with comorbidities and in-hospital mortality.

To devise a novel, simple chest x-ray (CXR) scoring system which would help in prognosticating the disease severity and ability to predict comorbidities and in-hospital mortality. We included a total of 343 consecutive hospitalised patients with COVID-19 in this study. The chest x-rays of these patients were scored retrospectively by three radiologists independently. We divided CXR in to six zones (right upper, mid & lower and left, upper mid & lower zones). We scored each zone as- 0, 1 or 2 as follows- if that zone was clear (0) Ground glass opacity (1) or Consolidation (2). A total of score from 0 to 12 could be obtained. A CXR score cut off ≥3 independently predicted mortality. Along with a relatively higher NPV ≥80%, it reinforced the importance of CXR score is a screening tool to triage patients according to risk of mortality. We propose that Pennine score is a simple tool which can be adapted by various countries, experiencing a large surge in number of patients, to decide which patient would need a tertiary Hospital referral/admission as opposed to patients that can be managed locally or at basic/primary care hospitals.

Can the Usage of the Chest X-Ray Scoring During Hospitalization in Patients with COVID-19 Predict the Severity of the Disease?

The prevalence of radiological involvement is considered a poor prognostic factor for coronavirus disease 2019 (COVID- 19). In our study, we aimed to investigate the threshold value of the chest X-ray (CXR) score, which would require the patient to be transferred to the intensive care unit (ICU) through scoring the CXR of COVID-19 patients receiving in-patient treatment. The patients that tested positive for COVID-19 on the basis of the polymerase chain reaction (PCR) test, who was hospitalized in our hospital between the dates of March 15 and May 30, 2020, were included in the study. The CXRs of these patients taken during hospitalization were scored. The threshold value of the CXR score of the patients transferred to the ICU was calculated. Patients were grouped according to the threshold value of the CXR score, and demographic data and other recorded parameters were compared. A total of 301 patients were included in this retrospective cross-sectional study. It was determined that finding of a CXR score threshold value of 5 or above during hospitalization predicted a transfer to the ICU with 90% sensitivity and 80% specificity. The use of broad-spectrum antibiotics, the laboratory parameters (leukocyte, neutrophil, C-reactive protein (CRP), procalcitonin, troponin, D-dimer, ferritin), and rate of transfer to ICU were found to be significantly higher in the group with a CXR score of 5 and above, compared to the group with CXR score below 5 (P < .001 in each). Finding high CXR scores during hospitalization due to COVID-19 may act as a warning in terms of the severity of the disease. It may be beneficial to examine the chest X-ray images during hospitalization with utmost care and take these images into account.

Initial findings in chest X-rays as predictors of worsening lung infection in patients with COVID-19: correlation in 265 patients

Background and aimsWe aimed to analyze the relationship between the initial chest X-ray findings in patients with severe acute respiratory syndrome due to infection with SARS-CoV-2 and eventual clinical worsening and to compare three systems of quantifying these findings. Material and methodsThis retrospective study reviewed the clinical and radiological evolution of 265 adult patients with COVID-19 attended at our center between March 2020 and April 2020. We recorded data related to patients’ comorbidities, hospital stay, and clinical worsening (admission to the ICU, intubation, and death). We used three scoring systems taking into consideration 6 or 8 lung fields (designated 6A, 6B, and 8) to quantify lung involvement in each patient’s initial pathological chest X-ray and to classify its severity as mild, moderate, or severe, and we compared these three systems. We also recorded the presence of alveolar opacities and linear opacities (fundamentally linear atelectasis) in the first chest X-ray with pathologic findings. ResultsIn the χ2 analysis, moderate or severe involvement in the three classification systems correlated with hospital admission (P = .009 in 6A, P = .001 in 6B, and P = .001 in 8) and with death (P = .02 in 6A, P = .01 in 6B, and P = .006 in 8). In the regression analysis, the most significant associations were 6B with alveolar involvement (OR 2.3; 95%CI 1.1.–4.7; P = .025;) and 8 with alveolar involvement (OR 2.07; 95% CI 1.01.–4.25; P = .046). No differences were observed in the ability of the three systems to predict clinical worsening by classifications of involvement in chest X-rays as moderate or severe. ConclusionModerate/severe extension in the three chest X-ray scoring systems evaluating the extent of involvement over 6 or 8 lung fields and the finding of alveolar opacities in the first pathologic X-ray correlated with mortality and the rate of hospitalization in the patients studied. No significant difference was found in the predictive ability of the three classification systems proposed.

CLINICO-RADIOLOGICAL CORRELATION AND OUTCOME OF COVID-19 PATIENTS PRESENTING TO A L2 CENTRE IN WESTERN UTTAR PRADESH

Objective of the current study was to evaluate the clinical features and severity of chest x-ray and its association with outcome in patients of Covid-19 in terms of hospital stay, discharge or death during hospital stay. A total of 100 patients above the age of 15 years diagnosed with Covid-19 by RT PCR of nasopharyngeal/oropharyngeal samples were included in the study. History of symptoms at onset was recorded, Chest-x-ray and hematological investigations were done. Chest x-ray findings were divided into three zones upper, middle and lower and each zone was given a score. Each zone involvement of either lung was given a score of 1. Maximum score was 6 with involvement of all zones of both lungs and minimum score was zero in patients with normal chest x-ray. These patients were followed up during their hospital stay in terms of oxygen requirement, Non invasive ventilation (NIV) requirement, Invasive mechanical ventilation, number of days of hospital stay and the outcome in terms of discharge or expired. Among the total of 100 patients, 58 were male and 42 were female patients. Maximum numbers of patients were in age group 45-60 years. Most common presenting complaint was fever followed by shortness of breath. Most common co morbidity was diabetes mellitus. We found that hypoxia at presentation, rate of intubation, and mortality was highest in patients with higher chest x-ray score and minimum in patients with chest x-ray score of zero. Discharge rate was highest in patient in lowest chest x-ray score. We conclude from the current study that chest x-ray score at the time of presentation has a predictive role in determining the risk of intubation and outcome in patients of covid-19.

Value of quantitative analysis in lung computed tomography in patients severely ill with COVID-19.

IntroductionQuantitative computed tomography (QCT) is used to objectively assess the degree of parenchymal impairment in COVID-19 pneumonia.Materials and methodsRetrospective study on 61 COVID-19 patients (severe and non-severe; 33 men, age 63+/-15 years) who underwent a CT scan due to tachypnea, dyspnoea or desaturation. QCT was performed using VCAR software. Patients’ clinical data was collected, including laboratory results and oxygenation support. The optimal cut-off point for CT parameters for predicting death and respiratory support was performed by maximizing the Youden Index in a receiver operating characteristic (ROC) curve analysis.ResultsThe analysis revealed significantly greater progression of changes: ground-glass opacities (GGO) (31,42% v 13,89%, p<0.001), consolidation (11,85% v 3,32%, p<0.001) in patients with severe disease compared to non-severe disease. Five lobes were involved in all patients with severe disease. In non-severe patients, a positive correlation was found between severity of GGO, consolidation and emphysema and sex, tachypnea, chest x-ray (CXR) score on admission and laboratory parameters: CRP, D-dimer, ALT, lymphocyte count and lymphocyte/neutrophil ratio. In the group of severe patients, a correlation was found between sex, creatinine level and death. ROC analysis on death prediction was used to establish the cut-off point for GGO at 24.3% (AUC 0.8878, 95% CI 0.7889–0.9866; sensitivity 91.7%, specificity 75.5%), 5.6% for consolidation (AUC 0.7466, 95% CI 0.6009–0.8923; sensitivity 83.3%, specificity 59.2%), and 37.8% for total (GGO+consolidation) (AUC 0.8622, 95% CI 0.7525–0.972; sensitivity 75%, specificity 83.7%). The cut-off point for predicting respiratory support was established for GGO at 18.7% (AUC 0.7611, 95% CI 0.6268–0.8954; sensitivity 87.5%, specificity 64.4%), consolidation at 3.88% (AUC 0.7438, 95% CI 0.6146–0.8729; sensitivity 100%, specificity 46.7%), and total at 23.5% (AUC 0.7931, 95% CI 0.673–0.9131; sensitivity 93.8%, specificity 57.8%).ConclusionQCT is a good diagnostic tool which facilitates decision-making regarding intensification of oxygen support and transfer to an intensive care unit in patients severely ill with COVID-19 pneumonia. QCT can make an independent and simple screening tool to assess the risk of death, regardless of clinical symptoms. Usefulness of QCT to predict the risk of death is higher than to assess the indications for respiratory support.