Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, Florida.
Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida.
Respir Care. 2022 Jul;67(7):871-878. doi: 10.4187/respcare.09761. Epub 2022 Apr 26.
Severity of radiographic abnormalities on chest radiograph in subjects with COVID-19 has been shown to be associated with worse outcomes, but studies are limited by different scoring systems, sample size, subject age, and study duration. Data regarding the longitudinal evolution of radiographic abnormalities and its association with outcomes are scarce. We sought to evaluate these questions using a well-validated scoring system (the Radiographic Assessment of Lung Edema [RALE] score) using data over 6 months from a large, multihospital health care system.
We collected clinical and demographic data and quantified radiographic edema on chest radiograph obtained in the emergency department (ED) as well as on days 1-2 and 3-5 (in those admitted) in subjects with a nasopharyngeal swab positive for SARS-CoV-2 by polymerase chain reaction (PCR) visiting the ED for coronavirus disease 2019 (COVID)-19-related complaints between March-September 2020. We examined the association of baseline and longitudinal evolution of radiographic edema with severity of hypoxemia and clinical outcomes.
Eight hundred and seventy subjects were included (median age 53.6; 50.8% female). Inter-rate agreement for RALE scores was excellent (interclass correlation coefficient 0.84 [95% CI 0.82-0.87], < .001). RALE scores correlated with hypoxemia as quantified by S /F (r = -0.42, < .001). Admitted subjects had higher RALE scores than those discharged (6 [2-11] vs 0 [0-3], < .001). An increase of RALE score ≥ 4 was associated with worse 30-d survival ( = .006). Larger increases in the RALE score were associated with worse survival.
The RALE score was reproducible and easily implementable in adult subjects presenting to the ED with COVID-19. Its association with physiologic parameters and outcomes at baseline and longitudinally makes it a readily available tool for prognostication and early ICU triage, particularly in patients with worsening radiographic edema.
COVID-19 患者的胸片显示的放射学异常严重程度与较差的结局相关，但研究受到不同评分系统、样本量、患者年龄和研究持续时间的限制。关于放射学异常的纵向演变及其与结局的关系的数据很少。我们使用来自大型多医院医疗保健系统的 6 个月以上的数据，使用经过良好验证的评分系统（放射学肺水肿评估[RALE]评分）来评估这些问题。
我们收集了临床和人口统计学数据，并在 2020 年 3 月至 9 月期间，对因与 COVID-19 相关的疾病而到急诊科就诊且鼻咽拭子经聚合酶链反应（PCR）检测 SARS-CoV-2 呈阳性的患者，定量分析其在急诊科获得的胸片（ED）以及在入院后的第 1-2 天和第 3-5 天（入院患者）的放射学水肿。我们检查了基线和放射学水肿的纵向演变与低氧血症严重程度和临床结局的关系。
共纳入 870 例患者（中位年龄 53.6 岁；50.8%为女性）。RALE 评分的组内一致性非常好（组内相关系数 0.84 [95%CI 0.82-0.87]， <.001）。RALE 评分与 S / F 定量的低氧血症相关（r = -0.42， <.001）。入院患者的 RALE 评分高于出院患者（6 [2-11] 比 0 [0-3]， <.001）。RALE 评分增加≥4 与 30 天生存率降低相关（ =.006）。RALE 评分的较大增加与生存率降低相关。
RALE 评分在因 COVID-19 到急诊科就诊的成年患者中具有可重复性和易于实施性。它与基线和纵向生理参数和结局的关系使其成为预后和早期 ICU 分诊的一种现成工具，特别是在放射学水肿加重的患者中。
