Shen B, Hoshmand-Kochi M, Abbasi A, Glass S, Jiang Z, Singer A J, Thode H C, Li H, Hou W, Duong T Q
Department of Radiology, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd, Stony Brook, NY 11794, USA.
Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd, Stony Brook, NY 11794, USA.
Clin Radiol. 2021 Jun;76(6):473.e1-473.e7. doi: 10.1016/j.crad.2021.02.005. Epub 2021 Feb 18.
To evaluate whether portable chest radiography (CXR) scores are associated with coronavirus disease 2019 (COVID-19) status and various clinical outcomes.
This retrospective study included 500 initial CXR from COVID-19-suspected patients. Each CXR was scored based on geographic extent and degree of opacity as indicators of disease severity. COVID-19 status and clinical outcomes including intensive care unit (ICU) admission, mechanical ventilation, mortality, length of hospitalisation, and duration on ventilator were collected. Multivariable logistic regression analysis was performed to evaluate the relationship between CXR scores and COVID-19 status, CXR scores and clinical outcomes, adjusted for code status, age, gender and co-morbidities.
The interclass correlation coefficients amongst raters were 0.94 and 0.90 for the extent score and opacity score, respectively. CXR scores were significantly (p < 0.01) associated with COVID-19 positivity (odd ratio [OR] = 1.49; 95% confidence interval [CI]: 1.27 - 1.75 for extent score and OR = 1.75; 95% CI: 1.42 - 2.15 for opacity score), ICU admission (OR = 1.19; 95% CI: 1.09 - 1.31 for extent score and OR = 1.26; 95% CI: 1.10 - 1.44 for opacity score), and invasive mechanical ventilation (OR = 1.22; 95% CI: 1.11 - 1.35 for geographic score and OR = 1.21; 95% CI: 1.05 - 1.38 for opacity score). CXR scores were not significantly different between survivors and non-survivors after adjusting for code status (p>0.05). CXR scores were not associated with length of hospitalisation or duration on ventilation (p>0.05).
Initial CXR scores have prognostic value and are associated with COVID-19 positivity, ICU admission, and mechanical ventilation.
评估便携式胸部X光片（CXR）评分是否与2019冠状病毒病（COVID-19）状态及各种临床结局相关。
这项回顾性研究纳入了500例疑似COVID-19患者的初始胸部X光片。每张胸部X光片根据病变范围和不透明度程度进行评分，以此作为疾病严重程度的指标。收集COVID-19状态及临床结局，包括重症监护病房（ICU）入住情况、机械通气、死亡率、住院时长及呼吸机使用时长。进行多变量逻辑回归分析，以评估胸部X光片评分与COVID-19状态之间、胸部X光片评分与临床结局之间的关系，并对编码状态、年龄、性别及合并症进行校正。
评分者间范围评分和不透明度评分的组内相关系数分别为0.94和0.90。胸部X光片评分与COVID-19阳性显著相关（p < 0.01）（范围评分的比值比[OR]=1.49；95%置信区间[CI]：1.27 - 1.75，不透明度评分的OR = 1.75；95% CI：1.42 - 2.15）、与ICU入住情况相关（范围评分的OR = 1.19；95% CI：1.09 - 1.31，不透明度评分的OR = 1.26；95% CI：1.10 - 1.44），以及与有创机械通气相关（范围评分的OR = 1.22；9 / 5% CI：1.11 - 1.35，不透明度评分的OR = 1.21；95% CI：1.05 - 1.38）。校正编码状态后，幸存者与非幸存者的胸部X光片评分无显著差异（p>0.05）。胸部X光片评分与住院时长或呼吸机使用时长无关（p>0.05）。
初始胸部X光片评分具有预后价值，且与COVID-19阳性、ICU入住情况及机械通气相关。
