Al-Yousif Nameer, Komanduri Saketram, Qurashi Hafiz, Korzhuk Anatoliy, Lawal Halimat O, Abourizk Nicholas, Schaefer Caitlin, Mitchell Kevin J, Dietz Catherine M, Hughes Ellen K, Brandt Clara S, Fitzgerald Georgia M, Joyce Robin, Chaudhry Asmaa S, Kotok Daniel, Rivera Jose D, Kim Andrew I, Shettigar Shruti, Lavina Allen, Girard Christine E, Gillenwater Samantha R, Hadeh Anas, Bain William, Shah Faraaz A, Bittner Matthew, Lu Michael, Prendergast Niall, Evankovich John, Golubykh Konstantin, Ramesh Navitha, Jacobs Jana J, Kessinger Cathy, Methé Barbara, Lee Janet S, Morris Alison, McVerry Bryan J, Kitsios Georgios D
medRxiv. 2022 Jun 14:2022.06.10.22276249. doi: 10.1101/2022.06.10.22276249.
Chest imaging is necessary for diagnosis of COVID-19 pneumonia, but current risk stratification tools do not consider radiographic severity. We quantified radiographic heterogeneity among inpatients with COVID-19 with the Radiographic Assessment of Lung Edema (RALE) score on Chest X-rays (CXRs).
We performed independent RALE scoring by ≥2 reviewers on baseline CXRs from 425 inpatients with COVID-19 (discovery dataset), we recorded clinical variables and outcomes, and measured plasma host-response biomarkers and SARS-CoV-2 RNA load from subjects with available biospecimens.
We found excellent inter-rater agreement for RALE scores (intraclass correlation co-efficient=0.93). The required level of respiratory support at the time of baseline CXRs (supplemental oxygen or non-invasive ventilation [n=178]; invasive-mechanical ventilation [n=234], extracorporeal membrane oxygenation [n=13]) was significantly associated with RALE scores (median [interquartile range]: 20.0[14.1-26.7], 26.0[20.5-34.0] and 44.5[34.5-48.0], respectively, p<0.0001). Among invasively-ventilated patients, RALE scores were significantly associated with worse respiratory mechanics (plateau and driving pressure) and gas exchange metrics (PaO2/FiO2 and ventilatory ratio), as well as higher plasma levels of IL-6, sRAGE and TNFR1 levels (p<0.05). RALE scores were independently associated with 90-day survival in a multivariate Cox proportional hazards model (adjusted hazard ratio 1.04[1.02-1.07], p=0.002). We validated significant associations of RALE scores with baseline severity and mortality in an independent dataset of 415 COVID-19 inpatients.
Reproducible assessment of radiographic severity revealed significant associations with clinical and physiologic severity, host-response biomarkers and clinical outcome in COVID-19 pneumonia. Incorporation of radiographic severity assessments may provide prognostic and treatment allocation guidance in patients hospitalized with COVID-19.
胸部影像学检查对于COVID-19肺炎的诊断是必要的，但目前的风险分层工具并未考虑影像学严重程度。我们使用胸部X光片（CXR）上的肺水肿影像学评估（RALE）评分对COVID-19住院患者的影像学异质性进行了量化。
我们由≥2名审阅者对425例COVID-19住院患者（发现数据集）的基线CXR进行独立的RALE评分，记录临床变量和结局，并测量有可用生物样本的受试者的血浆宿主反应生物标志物和SARS-CoV-2 RNA载量。
我们发现RALE评分具有出色的评分者间一致性（组内相关系数=0.93）。基线CXR时所需的呼吸支持水平（补充氧气或无创通气[n=178]；有创机械通气[n=234]，体外膜肺氧合[n=13]）与RALE评分显著相关（中位数[四分位间距]：分别为20.0[14.1-26.7]、26.0[20.5-34.0]和44.5[34.5-48.0]，p<0.0001）。在有创通气患者中，RALE评分与更差的呼吸力学（平台压和驱动压）和气体交换指标（PaO2/FiO2和通气比）以及更高的血浆IL-6、sRAGE和TNFR1水平显著相关（p<≤0.05）。在多变量Cox比例风险模型中，RALE评分与90天生存率独立相关（调整后的风险比1.04[1.02-1.07]，p=0.002）。我们在415例COVID-19住院患者的独立数据集中验证了RALE评分与基线严重程度和死亡率之间的显著关联。
对影像学严重程度进行可重复评估显示，其与COVID-19肺炎的临床和生理严重程度、宿主反应生物标志物及临床结局显著相关。纳入影像学严重程度评估可为COVID-19住院患者提供预后和治疗分配指导。
