Determining COVID-19 disease severity and outcome using sequential chest radiograph in a new designated COVID-19 hospital
Keywords:Brixia score, COVID-19, Corona complications, Prognosis
Background: COVID-19 pandemic to date has recorded around 37 million cases across the world. This study was done to appraise the prognostic importance of portable chest X-ray (CXR) and the Brixia scoring was then used to predict the outcome variables like hypoxia, non-invasive ventilation, intubation, sepsis, multiple organ dysfunction syndrome (MODS), recovery, death and post corona sequalae.
Methods: A 100 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 infection were included in the study, based on the inclusion and exclusion criteria. A CXR was done on admission and on day 3 following admission. The CXR Brixia score was calculated and was correlated with lab parameters, hypoxia, need for mechanical ventilator and clinical outcome variables. P value of <0.05 was taken as significant.
Results: The mean Brixia score on admission were 2.52±1.505, 6.18±2.969 and 12.05±3.251 in mild, moderate and severe category respectively and the scores that were calculated 3 days after admission were 2.52±1.505, 6.18±2.969 and 12.14±3.306 in mild, moderate and severe category respectively, it was found that mean Brixia scores were higher in patients with moderate and severe category compared to mild category. There was a statistically significant correlation between lymphopenia, lactate dehydrogenase (LDH), d-dimer, C-reactive protein (CRP) and serum ferritin with Brixia score on admission.
Conclusions: The simple and a bedside Brixia CXR score has shown that the higher scores predict a need for monitoring and management to prevent poor clinical outcome and mitigate complications and death. When this score is used along with other easily available biochemical parameters is useful in predicting clinical outcome and prognosis.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506.
Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020;295(3):685-91.
American College of Radiology. ACR recommendations for the use of chest radiography and computed tomography (CT) for suspected COVID-19 infection. 2020. Available at: www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection. Accessed on: 30 April 2020.
Stephanie S, Shum T, Cleveland H, Challa SR, Herring A, Jacobson FL, et al. Determinants of Chest X-Ray Sensitivity for COVID-19: A Multi-Institutional Study in the United States. Radiol Cardiothorac Imag. 2020;2(5):200337.
Smith DL, Grenier JP, Batte C, Spieler B. A Characteristic Chest Radiographic Pattern in the Setting of COVID-19 Pandemic. Radiol Cardiothorac Imag. 2020;2(5):200280.
Wong HYF, Lam HYS, Fong AH, Leung ST, Chin TW, Lo CSY, et al. Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology. 2020;296(2):72-8.
Cao AMY, Choy JP, Mohanakrishnan LN, Bain RF, van Driel ML. Chest radiographs for acute lower respiratory tract infections. Cochrane Database Syst Rev. 2013;12:CD009119.
Garcia-Santa-Cruz B, Sölter J, Bossa MN, Husch A. On the Composition and Limitations of Publicly Available COVID-19 X-Ray Imaging Datasets. Cornell University. 2020.
Borghesi A, Maroldi R. COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression. La Radiologia Medica. 2020:1.
Cozzi D, Albanesi M, Cavigli E, Moroni C, Bindi A, Luvarà S, et al. Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome. La Radiologia Medica. 2020:1.
Borghesi A, Zigliani A, Golemi S, Carapella N, Maculotti P, Farina D, Maroldi R. Chest X-ray severity index as a predictor of in-hospital mortality in coronavirus disease 2019: A study of 302 patients from Italy. Int J Infect Dis. 2020.