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

Abstract

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.

Prognostic and discriminatory abilities of imaging scoring systems in predicting COVID‐19 adverse outcomes

“…Full‐text screening yielded 56 articles from which data was subsequently extracted (Figure 1). The characteristics of the included studies are presented in Table [11–63]. Most studies are retrospective, they have a wide distribution worldwide in Italy, Japan, China, Netherlands.…”

The Correlations Between Clinical Characteristics and Inflammation Markers with Chest X-rays in COVID-19 Patients at Ulin Hospital

“…38 However, some studies stated that there was no significant relationship between outcomes and chest X-rays because it relied on comorbidities. 39…”

Clinical Features of COVID-19 in Elderly Patients: Tools for Predicting Outcomes Are Needed

“…Along with hypoxemic respiratory failure, acute decompensation of pre-existent comorbidities within the first week of infection was the most common cause of death [22]. Several studies investigated prognostic factors in elderlies with COVID-19 infections [23][24][25][26][27]. Scheffler et al investigated the prognostic role of subcutaneous and visceral adipose tissue using a quantification fat area on 64 patients with a mean age of 86.4 ± 6.0 years [23].…”

“…There was evidence of a positive association with the subcutaneous and visceral adipose tissue and in-hospital mortality and severe COVID-19 pneumonia [23]. The prognostic value of fever, chest X-ray (CXR), and clinical frailty (CFS) scores were investigated in 122 elderlies aged 65 or older, resulting in these being considered the main predictors of in-hospital mortality [24]. Fever, CXR, and CFS might predict outcomes more accurately than other individual risk factors, confirming the importance of multidimensional assessment of elderlies with COVID-19 [24].…”

“…The prognostic value of fever, chest X-ray (CXR), and clinical frailty (CFS) scores were investigated in 122 elderlies aged 65 or older, resulting in these being considered the main predictors of in-hospital mortality [24]. Fever, CXR, and CFS might predict outcomes more accurately than other individual risk factors, confirming the importance of multidimensional assessment of elderlies with COVID-19 [24]. The C 2 HEST has been proposed as a possible tool to evaluate outcomes in elderly patients with active or previous COVID-19 infection.…”