Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, TO, Italy.
Radiol Med. 2020 Dec;125(12):1271-1279. doi: 10.1007/s11547-020-01272-1. Epub 2020 Sep 7.
To assess the reliability of CXR and to describe CXR findings and clinical and laboratory characteristics associated with positive and negative CXR.
Retrospective two-center study on consecutive patients admitted to the emergency department of two north-western Italian hospitals in March 2020 with clinical suspicion of COVID-19 confirmed by RT-PCR and who underwent CXR within 24 h of the swab execution. 260 patients (61% male, 62.8 ± 15.8 year) were enrolled. CXRs were rated as positive (CXR+) or negative (CXR-), and features reported included presence and distribution of airspace opacities, pleural effusion and reduction in lung volumes. Clinical and laboratory data were collected. Statistical analysis was performed with nonparametric tests, binary logistic regression (BLR) and ROC curve analysis.
Sensitivity of CXR was 61.1% (95%CI 55-67%) with a typical presence of bilateral (62.3%) airspace opacification, more often with a lower zone (88.7%) and peripheral (43.4%) distribution. At univariate analysis, several factors were found to differ significantly between CXR+ and CXR-. The BLR confirmed as significant predictors only lactate dehydrogenase (LDH), C-reactive protein (CRP) and interval between the onset of symptoms and the execution of CXR. The ROC curve procedure determined that CRX+ was associated with LDH > 500 UI/L (AUC = 0.878), CRP > 30 mg/L (AUC = 0.830) and interval between the onset of symptoms and the execution of CXR > 4 days (AUC = 0.75). The presence of two out of three of the above-mentioned predictors resulted in CXR+ in 92.5% of cases, whereas their absence in 7.4%.
CXR has a low sensitivity. LDH, CRP and interval between the onset of symptoms and the execution of CXR are major predictors for a positive CXR.
评估 CXR 的可靠性，并描述与 CXR 阳性和阴性相关的 CXR 结果和临床及实验室特征。
这是一项回顾性的、在 2020 年 3 月于意大利西北部的两家医院急诊科进行的、连续纳入临床疑似 COVID-19 并经 RT-PCR 确诊且在拭子执行后 24 小时内接受 CXR 的患者的研究。共纳入 260 例患者（61%为男性，62.8±15.8 岁）。将 CXR 评为阳性（CXR+）或阴性（CXR-），并报告了空气腔隙混浊、胸腔积液和肺容积减少的存在和分布等特征。收集了临床和实验室数据。采用非参数检验、二项逻辑回归（BLR）和 ROC 曲线分析进行统计学分析。
CXR 的敏感性为 61.1%（95%CI 55-67%），典型表现为双侧（62.3%）空气腔隙混浊，更常见于下区（88.7%）和外周（43.4%）分布。单因素分析发现，CXR+和 CXR-之间有几个因素存在显著差异。BLR 证实乳酸脱氢酶（LDH）、C 反应蛋白（CRP）和症状发作与 CXR 执行之间的间隔时间是唯一的显著预测因子。ROC 曲线程序确定 CXR+与 LDH＞500 UI/L（AUC=0.878）、CRP＞30 mg/L（AUC=0.830）和症状发作与 CXR 执行之间的间隔＞4 天（AUC=0.75）相关。上述三个预测因子中有两个存在时，92.5%的情况下 CXR 为阳性，而不存在时为 7.4%。
CXR 的敏感性较低。LDH、CRP 和症状发作与 CXR 执行之间的间隔时间是 CXR 阳性的主要预测因子。
