Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergen
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Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department Maurizio Balbi 1,2 & Anna Caroli 3 & Andrea Corsi 1,2 & Gianluca Milanese 4 & Alessandra Surace 1,2 & Fabiano Di Marco 5,6 & Luca Novelli 5 & Mario Silva 4 & Ferdinando Luca Lorini 7 & Andrea Duca 8 & Roberto Cosentini 8 & Nicola Sverzellati 4 & Pietro Andrea Bonaffini 1,2 & Sandro Sironi 1,2 Received: 5 June 2020 / Revised: 1 September 2020 / Accepted: 8 September 2020 # The Author(s) 2020
Abstract Objectives To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support. Methods A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1–13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen’s kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression. Results GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support. Conclusions CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO2/FiO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support. Key Points • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO2/FIO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07270-1) contains supplementary material, which is available to authorized users. * Maurizio Balbi [email protected] 1
Department of Radiology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
2
University of Milano-Bicocca, Milan, Italy
3
Bioengineering Department, Istituto di Ricerche Farmacologic
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