Maroldi Roberto, Rondi Paolo, Agazzi Giorgio Maria, Ravanelli Marco, Borghesi Andrea, Farina Davide
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
Eur Radiol. 2021 Jun;31(6):4016-4022. doi: 10.1007/s00330-020-07504-2. Epub 2020 Dec 2.
We aim to demonstrate that a chest X-ray (CXR) scoring system for COVID-19 patients correlates with patient outcome and has a prognostic value.
This retrospective study included CXRs of COVID-19 patients that reported the Brixia score, a semi-quantitative scoring system rating lung involvement from 0 to 18. The highest (H) and lowest (L) values were registered along with scores on admission (A) and end of hospitalization (E). The Brixia score was correlated with the outcome (death or discharge).
A total of 953 patients met inclusion criteria. In total, 677/953 were discharged and 276/953 died during hospitalization. A total of 524/953 had one CXR and 429/953 had more than one CXR. H-score was significantly higher in deceased (median, 12; IQR 9-14) compared to that in discharged patients (median, 8; IQR 5-11) (p < 0.0001). In 429/953 patients with multiple CXR, A-score, L-score, and E-score were higher in deceased than in discharged patients (A-score 9 vs 8; p = 0.039; L-score 7 vs 5; p < 0.0003; E-score 12 vs 7; p < 0.0001). In the entire cohort, logistic regression showed a significant predictive value for age (p < 0.0001, OR 1.13), H-score (p < 0.0001, OR 1.25), and gender (p = 0.01, male OR 1.67). AUC was 0.863. In patients with ≥ 2 CXR, A-, L-, and E-scores correlated significantly with the outcome. Cox proportional hazards regression indicated age (p < 0.0001, HR 4.17), H-score (< 9, HR 0.36, p = 0.0012), and worsening of H-score vs A score > 3 (HR 1.57, p = 0.0227) as associated with worse outcome.
The Brixia score correlates strongly with disease severity and outcome; it may support the clinical decision-making, particularly in patients with moderate-to-severe signs and symptoms. The Brixia score should be incorporated in a prognostic model, which would be desirable, particularly in resource-constraint scenarios.
• To demonstrate the importance of the Brixia score in assessing and monitoring COVID-19 lung involvement. • The Brixia score strongly correlates with patient outcome and can be easily implemented in the routine reporting of CXR.
我们旨在证明一种针对新冠肺炎患者的胸部X线（CXR）评分系统与患者预后相关且具有预后价值。
这项回顾性研究纳入了报告了Brixia评分的新冠肺炎患者的胸部X线片，Brixia评分是一种半定量评分系统，对肺部受累情况从0到18进行评级。记录了最高（H）和最低（L）值以及入院时（A）和住院结束时（E）的评分。Brixia评分与预后（死亡或出院）相关。
共有953例患者符合纳入标准。总共677/953例患者出院，276/953例患者在住院期间死亡。共有524/953例患者有一张胸部X线片，429/953例患者有不止一张胸部X线片。与出院患者相比，死亡患者的H评分显著更高（中位数为12；四分位数间距为9 - 14），而出院患者的H评分中位数为8；四分位数间距为5 - 11（p < 0.0001）。在429/953例有多次胸部X线片的患者中，死亡患者的A评分、L评分和E评分高于出院患者（A评分9对8；p = 0.039；L评分7对5；p < 0.0003；E评分12对7；p < 0.0001）。在整个队列中，逻辑回归显示年龄（p < 0.0001，比值比1.13）、H评分（p < 0.0001，比值比1.25）和性别（p = 0.01，男性比值比1.67）具有显著的预测价值。曲线下面积为0.863。在有≥2张胸部X线片的患者中，A、L和E评分与预后显著相关。Cox比例风险回归表明年龄（p < 0.0001，风险比4.17）、H评分（<9，风险比0.36，p = 0.0012）以及H评分相对于A评分恶化>3（风险比1.57，p = 0.0227）与较差的预后相关。
Brixia评分与疾病严重程度和预后密切相关；它可能有助于临床决策，特别是在有中度至重度体征和症状的患者中。Brixia评分应纳入预后模型，这将是可取的，特别是在资源有限的情况下。
• 证明Brixia评分在评估和监测新冠肺炎肺部受累方面的重要性。• Brixia评分与患者预后密切相关，并且可以很容易地在胸部X线片的常规报告中实施。
Zotero 插件
