Clinical and Chest Radiography Features Determine Patient Outcomes in Young and Middle-aged Adults with COVID-19

Abstract

Background: Chest radiography (CXR) has not been validated for its prognostic utility in evaluating patients with coronavirus disease 2019 .Purpose: The purpose of this study was to analyze the prognostic value of a CXR severity scoring system for younger (non-elderly) patients with COVID-19 upon initial presentation to the emergency department (ED). Outcomes of interest included hospitalization, intubation, prolonged stay, sepsis, and death. Materials & Methods:In this retrospective study, patients between the ages of 21 and 50 years who presented to EDs of an urban multicenter health system from March 10 -26, 2020 with COVID-19 confirmation on real-time reverse transcriptase polymerase chain reaction (RT-PCR) were identified.Each patient's ED CXR was divided into 6 zones and examined for opacities by two cardiothoracic radiologists with scores collated into a total concordant lung zone severity score. Clinical and laboratory variables were collected. Multivariable logistic regression was utilized to evaluate the relationship between clinical parameters, CXR scores, and patient outcomes. Results:The study included 338 patients: 210 males (62%), median age 39 [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. After adjustment for demographics and co-morbidities, independent predictors of hospital admission (n=145, 43%) were CXR severity score ≥ 2 (OR: 6.2, 95% CI 3.5-11, p<0.001) and obesity (OR 2.4 (1.1-5.4) or morbid obesity. Of patients who were admitted, a CXR score ≥3 was an independent predictor of intubation (n=28) (OR: 4.7, 95% CI 1.8-13, p=0.002) as was hospital site. We found no significant difference in primary outcomes across race/ethnicity, those with a history of tobacco use, asthma or diabetes mellitus type II. Conclusion:For patients aged 21-50 with COVID-19 presenting to the emergency department, a chest xray severity score was predictive of risk for hospital admission and intubation.

Chest X-Ray Findings and Temporal Lung Changes in Patients with COVID-19 Pneumonia

“…Also, in our study there was a signi cant association between symptoms and chest x-ray ndings. This nding should encourage the health professionals to utilize chest x-ray in the diagnosis and follow up of patients with COVID-19 which is in agreement with a study conducted by Toussie et al who reported that chest xray severity score was found to be a predictive index of risk for hospital admission and intubation (29), and mobile chest x-rays were found to be bene cial in the follow up of critically ill COVID-19 patients in another study (27).…”

Revisiting MERS-CoV Outbreak Chest Radiographic Initial Findings, Temporal Progression and Correlation to Outcomes: Insights for the COVID-19 Pandemic

“…Further, the risk of MERS-CoV mortality in our group was found to be highest when patients where >44 years-old. Herein lies another similarity with recent observations of COVID-19, of which older age and more substantial lung involvement are associated with poorer prognosis 8,17,30 .…”

“…Furthermore, the reported imaging magni cations of both viruses are remarkably similar [7][8][9] . The utility of chest X-rays (CXRs) in investigating MERS-CoV and COVID-19 is practically convenient, yet the number of dedicated studies addressing the CXR ndings of both coronaviruses is limited, especially when compared to that of their CT features 6,[10][11][12][13][14][15][16][17] .…”

A Novel Automated Method for COVID-19 Infection and Lung Segmentation using Deep Neural Networks

“…Chest radiography imaging, which can be either x-rays or CT (Computed Tomography) scans has important applications in the diagnosis of COVID-19 [17]. Medical professionals use these scans of the chest of the patient to get more information about the presence and extent of the virus, the severity of the spread as well as regions of infection.…”