Dept of Clinical Radiology, NHS Salisbury Foundation Trust, Wiltshire, United Kingdom; Dept of Clinical Imaging, Al Wakra hospital, Hamad Medical Corporation, Qatar.
Dept of Clinical Imaging, Al Wakra hospital, Hamad Medical Corporation, Qatar.
Clin Imaging. 2023 Mar;95:65-70. doi: 10.1016/j.clinimag.2022.12.002. Epub 2022 Dec 28.
To measure the reliability and reproducibility of a chest radiograph severity score (CSS) in prognosticating patient's severity of disease and outcomes at the time of disease presentation in the emergency department (ED) with coronavirus disease 2019 (COVID-19).
We retrospectively studied 1275 consecutive RT-PCR confirmed COVID-19 adult patients presenting to ED from March 2020 through June 2020. Chest radiograph severity score was assessed for each patient by two blinded radiologists. Clinical and laboratory parameters were collected. The rate of admission to intensive care unit, mechanical ventilation or death up to 60 days after the baseline chest radiograph were collected. Primary outcome was defined as occurrence of ICU admission or death. Multivariate logistic regression was performed to evaluate the relationship between clinical parameters, chest radiograph severity score, and primary outcome.
CSS of 3 or more was associated with ICU admission (78 % sensitivity; 73.1 % specificity; area under curve 0.81). CSS and pre-existing diabetes were independent predictors of primary outcome (odds ratio, 7; 95 % CI: 3.87, 11.73; p < 0.001 & odds ratio, 2; 95 % CI: 1-3.4, p 0.02 respectively). No significant difference in primary outcome was observed for those with history of hypertension, asthma, chronic kidney disease or coronary artery disease.
Semi-quantitative assessment of CSS at the time of disease presentation in the ED predicted outcomes in adults of all age with COVID-19.
测量胸部 X 线严重程度评分（CSS）在预测 2019 年冠状病毒病（COVID-19）患者在急诊科就诊时疾病严重程度和结局方面的可靠性和可重复性。
我们回顾性研究了 2020 年 3 月至 6 月期间因 COVID-19 连续 1275 例 RT-PCR 确诊的成年患者。由两位盲法放射科医生对每位患者进行胸部 X 线严重程度评分评估。收集临床和实验室参数。收集发病基线胸部 X 线后 60 天内入住重症监护病房、机械通气或死亡的发生率。主要结局定义为入住重症监护病房或死亡。进行多变量逻辑回归以评估临床参数、胸部 X 线严重程度评分和主要结局之间的关系。
CSS 为 3 或更高与入住重症监护病房有关（78%的敏感性；73.1%的特异性；曲线下面积 0.81）。CSS 和预先存在的糖尿病是主要结局的独立预测因子（比值比，7；95%可信区间：3.87，11.73；p<0.001&比值比，2；95%可信区间：1-3.4，p=0.02）。对于有高血压、哮喘、慢性肾脏病或冠状动脉疾病病史的患者，主要结局没有显著差异。
急诊科就诊时 CSS 的半定量评估预测了所有年龄段 COVID-19 成年患者的结局。
