Role of Chest X-Ray in Coronavirus Disease and Correlation of Radiological Features with Clinical Outcomes in Indian Patients

Abstract

Recent literature has reported that radiological features of coronavirus disease (COVID-19) patients are influenced by computed tomography. This study aimed to assess the characteristic chest X-ray features of COVID-19 and correlate them with clinical outcomes of patients. This retrospective study included 120 COVID-19 patients. Baseline chest X-rays and serial chest X-rays were reviewed. A severity index in the form of maximum radiological assessment of lung edema (RALE) score was calculated for each lung, and scores of both the lungs were summed to obtain a final score. The mean ± standard deviation (SD) and frequency (%) were determined, and an unpaired t test, Spearman’s rank correlation coefficient, and logistic regression analyses were performed for statistical analyses. Among 120 COVID-19 patients, 74 (61.67%) and 46 (38.33%) were males and females, respectively; 64 patients (53.33%) had ground-glass opacities (GGO), 55 (45.83%) had consolidation, and 38 (31.67%) had reticular-nodular opacities, with lower zone distribution (50%) and peripheral distribution (41.67%). Baseline chest X-ray showed a sensitivity of 63.3% in diagnosing typical findings of SARS-CoV-2 pneumonia. The maximum RALE score was 2.13 ± 1.9 in hospitalized patients and 0.57 ± 0.77 in discharged patients ( p value <0.0001). Spearman’s rank correlation coefficient between maximum RALE score and clinical outcome parameters was as follows: age, 0.721 ( p value <0.00001); >10 days of hospital stay, 0.5478 ( p value <0.05); ≤10 days of hospital stay, 0.5384 ( p value <0.0001); discharged patients, 0.5433 ( p value <0.0001); and death, 0.6182 ( p value = 0.0568). The logistic regression analysis revealed that maximum RALE scores (0.0932 [0.024–0.367]), (10.730 [2.727–42.206]), (1.258 [0.990–1.598]), and (0.794 [0.625–1.009]) predicted discharge, death, >10 days of hospital stay, and ≤10 days of hospital stay, respectively. The study findings suggested that the RALE score can quantify the extent of COVID-19 and can predict the prognosis of patients.

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

“…Our findings, that approximately one-third of patients hospitalized with COVID-19 had abnormal X-ray findings and WBCs counts, with 17.1% manifesting out of range of CRP levels, is similar to a study from Jordan regarding abnormal X-ray findings [ 75 ] and China regarding WBCs [ 76 ]. This contrasts with previous studies in Pakistan where there was a higher percentage of X-ray abnormalities among hospitalized patients [ 77 , 78 ], as well as studies from India and the USA [ 79 , 80 ]. In addition, in a published study in the USA, almost all hospitalized patients with COVID-19 had raised CRP levels [ 81 ].…”

Utility of a Pulmonary Oedema Score for Predicting the Need for Mechanical Ventilation in COVID-19 Patients in a General Hospital

“…We did not find any other published articles that studied the predictive value of the RALE score for the requirement for mechanical ventilation to compare with our findings. The RALE score has been used as a predictor of mortality from COVID-19 ( 27 , 28 , 29 , 30 , 31 ), to assess the severity of COVID-19 ( 32 , 33 ) or to guide the discharge of patients from a service or hospital ( 27 , 32 ). One study compared the usefulness of different scoring methods for radiological images, including RALE, and their association with ARDS ( 34 ) during the SARS-CoV-2 epidemic.…”

“…Different studies have reported different cut-off levels of the RALE score associated with different outcomes. Some studies used the original version of the score, with a maximum value of 48 ( 28 , 30 , 32 , 33 ) while others ( 27 , 29 , 31 , 34 ), like us, used the Wong version of the score, with a maximum value of 8.…”

The comparison of chest X-ray and CT visibility according to size and lesion types in the patients with COVID-19

“…However, radiological evaluations are frequently used for rapid diagnosis. It is recommended that CT should be preferred primarily in cases where there is clinical and PCR incompatibility, as well as in the presence of embolism, malignancy, and severe respiratory distress (14,10). CXR is the first preferred examination in the radiological algorithm.…”

“…CT was used as a screening test almost as widely as PCR in our country at the beginning of the pandemic (8). However, the use of CT decreased with the increase in experience about the disease in the forthcoming days and clinical findings and the use of Chest X-rays (CXR) became more prominent (9,10). The effectiveness of CRX in detecting COVID-19's radiological findings is quite low compared to CT.…”