Brixia Score as Predictor of D-Dimer Levels of COVID-19 Patients in Intensive Care Unit

Abstract

Background: COVID-19 is caused by a novel virus that can cause lung abnormalities which can be measured with new chest x-ray scoring system named Brixia score. In COVID-19 patients, coagulation disorders are often found that can be seen through D-Dimer levels. This study aimed to prove the Brixia Score as a predictor of D-Dimer levels. Subjects and Method: This study was an observational analytic study with a cross-sectional approach. The subjects were 94 COVID-19 patients which taken from ICU Melati 1 Dr. Moewardi General Hospital, Surakarta from March 2021 to August 2021 who met the exclusion and inclusion criteria. The independent variable is Brixia score performed by radiologists and dependent variable is D-Dimer levels taken from laboratory results. Sampling was obtained by purposive sampling and the data were investigated using the receiver operating characteristic (ROC) curve. Results: 94 samples were obtained for analysis. The average Brixia Score of patients with D-Dimer <2 µg/mL was Mean= 15.85; SD= 1.43 and D-Dimer ≥2 µg/mL was Mean= 17.29; SD= 0.96. There was a significant difference between the Brixia Score of patients with D-Dimer <2 µg/mL and D-Dimer ≥2 µg/mL (p<0.001). Analysis with the ROC curve shows an area under the curve (AUC) of 0.793. The optimal cutoff value of the Brixia Score for predicting D-Dimer levels was 16.5 (sensitivity 77.9%, specificity 73.1%). Conclusion: Brixia Score proved to be a predictor of D-Dimer levels of COVID-19 patients in ICU care.

D-Dimer and Brixia Score to Mortality in COVID-19 Patients

“…This condition can lead to thrombosis and degradation of pulmonary vascular fibrin and cause a hypoxemic state that activates hypoxic triggering factors that activate more pro-inflammatory cytokines, tissue factor, and PAI-1, and cause excessive thrombosis indicated by the presence of increased D-dimer. 7 This study has several areas for improvement. Sampling of D-dimer and Brixia scores in this study was taken at any time, regardless of previous medical history or history of previous therapy.…”

“…The assessment used four types of scores, namely 0-3, with value 0 (no infiltrate), 1 (interstitial infiltrate present), 2 (interstitial and alveolar infiltrate present), and 3 (interstitial and alveolar infiltrate present (alveolar is more prominent)). 7 The score was calculated by one experienced thoracic consultant radiologist and one pulmonologist. The initial Brixia scores were checked when the patient first came to the ER, and the final value was the last evaluation when the patient passed away.…”