Clinical utility of chest radiography for severe COVID-19

Abstract

Background: Chest radiography (CXR) is performed more widely and readily than CT for the management of coronavirus disease , but there remains little data on its clinical utility. This study aims to assess the diagnostic performance of CXR, with emphasis on its predictive value, for severe COVID-19 disease.Methods: A retrospective cohort study was conducted, 358 chest radiographs were performed on 109 COVID-19 patients (median age 44.4 years, 58 males and 30 with comorbidities) admitted between 22 January 2020 and 15 March 2020. Each CXR was reviewed and scored by three radiologists in consensus using a 72-point COVID-19 Radiographic Score (CRS). Disease severity was determined by the need for supplemental oxygen and mechanical ventilation.Results: Patients who needed supplemental oxygen (n=19, 17.4%) were significantly older (P<0.001) and significantly more of them had co-morbidities (P=0.011). They also had higher C-reactive protein (CRP) (P<0.001), higher lactate dehydrogenase (LDH) (P<0.001), lower lymphocyte count (P<0.001) and lower hemoglobin (Hb) (P=0.001). Their initial (CRS initial ) and maximal CRS (CRS max ) were higher (P<0.001).Adjusting for age and baseline hemoglobin, the AUROC of CRS max (0.983) was as high as CRP max (0.987) and higher than the AUROC for lymphocyte count min (0.897), and LDH max (0.900). The AUROC for CRS initial was slightly lower (0.930). CRS initial ≥5 had a sensitivity of 63% and specificity of 92% in predicting the need for oxygen, and 73% sensitivity and 88% specificity in predicting the need for mechanical ventilation.CRS between the 6 th and 10 th day from the onset of symptoms (CRS D6-10 ) ≥5 had a sensitivity of 89% and specificity of 95% in predicting the need for oxygen, and 100% sensitivity and 86% specificity in predicting the need for mechanical ventilation.Conclusions: Adjusting for key confounders of age and baseline Hb, CRS max performed comparable to or better than laboratory markers in the diagnosis of severe disease. CXR performed between the 6 th and 10 th days from symptom onset was a better predictor of severe disease than CXR performed earlier at presentation. A benign clinical course was seen in CXR that were normal or had very mild abnormalities.

The time course of chest CT lung changes in COVID-19 patients from onset to discharge

“…In addition, there was a higher proportion of patients with severe COVID-19 experiencing fibrosis and air bronchogram [ 19 , 20 ]. An increasing trend in the prevalence of fibrosis occurrence in COVID-19 patients from admission to discharge was also observed and described in our study, which provides important information demonstrating the progress of fibrosis and lung damage.…”

High-risk chest radiographic features associated with COVID-19 disease severity

“…We conducted a retrospective cohort study of all COVID-19 patients with baseline CXR admitted to our center between January 22 and March 15 2020, as part of a separate study that developed a quantitative COVID-19 radiographic score [ 9 ]. During this study period, all patients with confirmed COVID-19 infection were admitted for inpatient care and isolation, regardless of disease severity.…”

“…Several quantitative CT radiographic scores have been developed to predict patients at risk of developing severe illness [ 7 , 8 ]. Recently, our group showed that an objective CXR radiographic score, modified from the Radiographic Assessment of Lung Edema (RALE) score for acute respiratory distress syndrome (ARDS), could quantify disease severity associated with supplemental oxygen requirement and mechanical ventilation, and could predict clinical deterioration if done within six to ten days from illness onset [ 9 ]. Borghesi et al have also demonstrated the value of CXR in assessing disease severity using a similar scoring system [ 10 ].…”

Chest Radiography in Coronavirus Disease 2019 (COVID-19): Correlation with Clinical Course

“…When there was no disease progression after normal or mild findings were found on CXR, patients recovered after a relatively benign course of illness (cases 1 and 2). However, when disease progression in the form of bilateral consolidation with lower zone predominance that reached peak severity between days 10-12 was present, 18,19 patients deteriorated and required either supplemental oxygen therapy or mechanical ventilation (cases 3, 4 and 5).…”