Temple University Lewis Katz School of Medicine, Philadelphia, PA.
Department of Radiology, Temple University Hospital Network, Philadelphia, PA.
Medicine (Baltimore). 2021 Nov 12;100(45):e27663. doi: 10.1097/MD.0000000000027663.
The value of chest radiography (CXR) in detection and as an outcome predictor in the management of patients with coronavirus disease-2019 (COVID-19) has not yet been fully understood.To validate a standardized CXR scoring system and assess its prognostic value in hospitalized patients found to have COVID-19 by imaging criteria and to compare it to computed tomography (CT).In this cross-sectional chart review study, patients aged 18-years or older who underwent chest CT at a single institution with an imaging-based diagnosis of COVID-19 between March 15, 2020 to April 15, 2020 were included. Each patient's CXR and coronal CT were analyzed for opacities in a 6-zonal assessment method and aggregated into a "Sextus score." Inter-reader variability and correlation between CXR and coronal CT images were investigated to validate this scoring system. Univariable and multiple logistic regression techniques were used to investigate relationships between CXR scores and clinical parameters in relation to patient outcomes.One hundred twenty-four patients (median [interquartile range] age 58.5 [47.5-69.0] years, 72 [58%] men, 58 [47%] Blacks, and 35 [28%] Hispanics) were included. The CXR Sextus score (range: 0-6) was reliable (inter-rater kappa = 0.76; 95% confidence interval [CI]: 0.69-0.83) and correlated strongly with the CT Sextus score (Spearman correlation coefficient = 0.75, P < .0001). Incremental increases of CXR Sextus scores of 2 points were found to be an independent predictor of intubation (adjusted odds ratio [95% CI]: 4.49 [1.98, 10.20], P = .0003) and prolonged hospitalization (≥10 days) (adjusted odds ratio [95% CI]: 4.06 [1.98, 8.32], P = .0001).The CXR Sextus score was found to be reproducible and CXR-CT severity scores were closely correlated. Increasing Sextus scores were associated with increased risks for intubation and prolonged hospitalization for patients with COVID-19 in a predominantly Black population. The CXR Sextus score may provide insight into identifying and monitoring high-risk patients with COVID-19.
胸部 X 线摄影（CXR）在检测和作为管理 2019 年冠状病毒病（COVID-19）患者的预后指标方面的价值尚未完全了解。为了验证标准化的 CXR 评分系统，并评估其在通过影像学标准发现的 COVID-19 住院患者中的预后价值，并将其与计算机断层扫描（CT）进行比较。在这项横断面图表回顾研究中，纳入了 2020 年 3 月 15 日至 4 月 15 日期间在一家机构接受基于影像学的 COVID-19 诊断的胸部 CT 检查的年龄在 18 岁或以上的患者。使用 6 区评估方法对每位患者的 CXR 和冠状 CT 进行分析，并将其汇总为“ sextus 评分”。研究了 CXR 和冠状 CT 图像之间的读者间变异性和相关性，以验证该评分系统。使用单变量和多逻辑回归技术研究 CXR 评分与临床参数之间的关系与患者结局。共纳入 124 名患者（中位数[四分位间距]年龄 58.5[47.5-69.0]岁，72[58%]男性，58[47%]黑人，35[28%]西班牙裔）。CXR sextus 评分（范围：0-6）可靠（组内相关系数 kappa=0.76；95%置信区间[CI]：0.69-0.83），与 CT sextus 评分密切相关（Spearman 相关系数=0.75，P<.0001）。发现 CXR sextus 评分增加 2 分是插管的独立预测因素（调整优势比[95%CI]：4.49[1.98,10.20]，P=.0003）和延长住院时间（≥10 天）（调整优势比[95%CI]：4.06[1.98,8.32]，P=.0001）。CXR sextus 评分发现是可重复的，CXR-CT 严重程度评分密切相关。在以黑人为主的人群中， sextus 评分的增加与 COVID-19 患者插管和住院时间延长的风险增加相关。CXR sextus 评分可能为识别和监测 COVID-19 高危患者提供了新视角。
