Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19

Al-Yousif, Nameer; Komanduri, Saketram; Qurashi, H.M.S.; Korzhuk, Anatoliy; Lawal, Halimat; Abourizk, Nicholas; Schaefer, Caitlin; Mitchell, Kevin J.; Dietz, Catherine M; Hughes, Ellen K.; Brandt, Clara S; Fitzgerald, Georgia M; Joyce, Robin; Chaudhry, Asmaa S; Kotok, Daniel; Rivera, Jose D; Kim, Andrew I; Shettigar, Shruti; Lavina, A.; Girard, C.; Gillenwater, S.; Hadeh, Anas; Bain, William; Shah, Faraaz; Bittner, Matthew; Lu, Michael; Prendergast, N.; Evankovich, John; Golubykh, K.; Ramesh, N.; Jacobs, Jana J; Kessinger, Cathy; Methé, Barbara A.; Lee, Janet; Morris, Alison; McVerry, Bryan J.; Kitsios, Georgios D

doi:10.1136/bmjopen-2022-066626

Cited by 8 publications

(4 citation statements)

References 31 publications

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“…We found no significant correlation between mcfDNA and SARS-CoV-2 viral load (quantified by vRNA qPCR in plasma and endotracheal aspirate samples, when available), radiographic severity (quantified by radiographic assessment of lung edema [RALE] scores) or clinical severity by the WHO ordinal scale. 25 , 26 , 27 However, there was a weak, significant correlation between hcfDNA and RALE scores (r = 0.33, p = 0.03).…”

Section: Resultsmentioning

confidence: 90%

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Noninvasive diagnosis of secondary infections in COVID-19 by sequencing of plasma microbial cell-free DNA

Lisius,

Duttagupta,

Ahmed

et al. 2023

iScience

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Section: Resultsmentioning

confidence: 90%

“…We quantified radiographic edema of baseline chest X-rays with the Radiographic Assessment of Lung Edema (RALE) score with the use of the PulmAnnotator software. 27 , 36 …”

Section: Methodsmentioning

confidence: 99%

Noninvasive diagnosis of secondary infections in COVID-19 by sequencing of plasma microbial cell-free DNA

Lisius,

Duttagupta,

Ahmed

et al. 2023

iScience

Self Cite

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“…Furthermore, our study cohort is a different patient group because the LUS exams were performed per protocol in the DARTS project, while the CXRs were performed on clinical indication. Studies on the RALE score as a predictive tool on mortality in ventilated ICU patients with ARDS show conflicting results, similar to the LUS aeration score [ 3 , 5 , 6 , 24 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

Associations of early changes in lung ultrasound aeration scores and mortality in invasively ventilated patients: a post hoc analysis

Sinnige,

Filippini,

Hagens

et al. 2024

Respir Res

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Background Lung ultrasound (LUS) in an emerging technique used in the intensive care unit (ICU). The derivative LUS aeration score has been shown to have associations with mortality in invasively ventilated patients. This study assessed the predictive value of baseline and early changes in LUS aeration scores in critically ill invasively ventilated patients with and without ARDS (Acute Respiratory Distress Syndrome) on 30- and 90-day mortality. Methods This is a post hoc analysis of a multicenter prospective observational cohort study, which included patients admitted to the ICU with an expected duration of ventilation for at least 24 h. We restricted participation to patients who underwent a 12-region LUS exam at baseline and had the primary endpoint (30-day mortality) available. Logistic regression was used to analyze the primary and secondary endpoints. The analysis was performed for the complete patient cohort and for predefined subgroups (ARDS and no ARDS). Results A total of 442 patients were included, of whom 245 had a second LUS exam. The baseline LUS aeration score was not associated with mortality (1.02 (95% CI: 0.99 – 1.06), p = 0.143). This finding was not different in patients with and in patients without ARDS. Early deterioration of the LUS score was associated with mortality (2.09 (95% CI: 1.01 – 4.3), p = 0.046) in patients without ARDS, but not in patients with ARDS or in the complete patient cohort. Conclusion In this cohort of critically ill invasively ventilated patients, the baseline LUS aeration score was not associated with 30- and 90-day mortality. An early change in the LUS aeration score was associated with mortality, but only in patients without ARDS. Trial registration ClinicalTrials.gov, ID NCT04482621.

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“…The Radiographic Assessment of Lung Edema (RALE) scores on Chest X-ray (CXR)s were collected upon admission. 24 An experienced pulmonologist (Y.S.) scored the first available CXRs.…”

Section: Methodsmentioning

confidence: 99%

Remdesivir versus Favipiravir in Hospitalized Patients with Moderate to Severe COVID-19 Pneumonia: A Propensity Score-Matched Retrospective Cohort Study

Chavalertsakul,

Sutherasan,

Petnak

et al. 2024

IJGM

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Background Remdesivir treatment was associated with a reduced 28-day mortality and recovery time among patients hospitalized with severe COVID-19. Favipiravir is broadly used to treat COVID-19. However, various studies have had conflicting results on the efficacy of favipiravir for COVID-19. We hypothesized that remdesivir is more effective in clinical outcomes regarding the 29-day mortality rates, length of stay, and recovery rate than favipiravir in patients with moderate to severe COVID-19 pneumonia. Methods We performed a retrospective cohort study that included adult hospitalized COVID-19 pneumonia patients with hypoxemia. Patients were classified into two groups according to the antiviral drugs. Age, oxygen saturation, fraction of inspired oxygen, and Charlson comorbidity index were used for propensity score matching. The primary objective was to determine whether the type of antiviral agent is associated with 29-day mortality. Other outcomes were the 15-day recovery rate and the length of intensive care unit or hospital stay. Results A total of 249 patients with moderate to severe COVID-19 pneumonia were included. With an adjustment for propensity score-matched, there were 204 patients for further analysis (102 patients in each antiviral drug group). Remdesivir patients had higher Radiographic Assessment of Lung Edema (RALE) scores on Chest X-ray (14.32±9.08 vs 11.34±8.46; standardized mean difference =33.9%). The Charlson Comorbidity Index Scores were comparable. The prevalences of diabetes, obesity, hypertension, and non-HIV immunocompromised state were higher in the remdesivir group. Regarding the primary outcomes, after adjusting by diabetes, obesity, and RALE score, there was no difference in the 29-day mortality rate between both groups [26 patients (25.5%) in the remdesivir group vs 28 patients (27.5%) in the favipiravir group]. The Kaplan-Meier curve analysis at 29 days indicated no significant difference in cumulative survival rate. The two groups’ adjusted hazard ratio was 0.72; 95% CI, 0.41 to 1.25, p =0.24. A Kaplan-Meier analysis on the 15-day cumulative survival rate observed a trend towards a higher survival rate in the remdesivir group (adjusted hazard ratio 0.41; 95% CI, 0.20 to 0.84; p= 0.02) The proportion of patients who recovered on day 15, the length of intensive care unit(ICU) stays, and the hospital stay were not different between remdesivir and favipiravir groups (62 patients (60.8%) vs 56 patients (54.9%), p=0.39; 11.48 ± 11.88 days vs 10.87 ± 9.31 days, p =0.69; and 16.64±14.28 days vs 16.59 ±11.31 days, p =0.98, respectively). Conclusion In patients with moderate to severe COVID-19 pneumonia, Remdesivir did not demonstrate superior benefits over Favipiravir regarding 29-day mortality, 15-day recovery rates, or hospital and ICU stay lengths. However, further investigation into the 15-day cumulativ...

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Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19

Cited by 8 publications

References 31 publications

Noninvasive diagnosis of secondary infections in COVID-19 by sequencing of plasma microbial cell-free DNA

Noninvasive diagnosis of secondary infections in COVID-19 by sequencing of plasma microbial cell-free DNA

Associations of early changes in lung ultrasound aeration scores and mortality in invasively ventilated patients: a post hoc analysis

Remdesivir versus Favipiravir in Hospitalized Patients with Moderate to Severe COVID-19 Pneumonia: A Propensity Score-Matched Retrospective Cohort Study

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