Chest radiograph characteristics in COVID-19 infection and their association with survival

Abstract

Purpose This study aims to systematically grade CXRs of COVID-19 patients to find associations between CXR (chest radiographs) characteristics and clinical outcomes. Methods A retrospective review and grading of CXRs in 161 COVID-19 positive patients was caried out in this single centre study. CXR changes primarily constituted that of presence or absence of ground glass opacification (GGO) or consolidation and their distribution across both lung fields. We used two grading systems normal/ mild/ moderate/ severe grading and a numeric 0−8 grading system. We defined mild severity as up to 25 % lung involvement, moderate as 25–62.5 % and severe as 62.5–100% lung involvement. Results Peripheral GGO in lower +/- mid zones of the lungs is the most common finding. Mid zone and perihilar GGO is associated with increased mortality. We additionally show that CXRs have a higher severity score in the non-survivor group and a CXR graded as severe has a relative risk ratio for mortality of 3.28. Finally, we describe the change in CXR severity with length of symptoms, finding 42.3 % of CXR were normal in the first 2 days of symptoms and 0% at 13 days. Conclusion Using a systematic approach to reviewing and grading CXRs in Covid-19 positive patients we clearly demonstrate that grading, location of airspace abnormalities and rate of CXR changes are related to clinical outcome.

“Keep it simple – a lesson from COVID-19”: highlighting the utility of chest X-rays in ARDS-associated illnesses through the Zonal Scoring System

“…In agreement with the available literature, we saw that most patients with CXR scores ≥ 1 had bilateral, peri-pheral alveolar, and interstitial infiltrates [ 14 , 22 , 23 ]. We also reported a pleural effusion prevalence of 7.05% according to current reviews [ 24 , 25 ].…”

“…Like infiltrates, effusions are prevalent bilaterally, ascribed to the ACE 2-associated cytokine-mediated lung damage [ 25 ]. A higher frequency of pleural effusions in the left compared to the right could be attributed to a reporting bias due to a transpicuous right costophrenic window [ 23 , 26 ]. A higher ICXRS was significantly associated with categorical outcomes of ICU admission, intubation, and disease severity.…”

A Comparison of CXR-CAD Software to Radiologists in Identifying COVID-19 in Individuals Evaluated for Sars CoV 2 Infection in Malawi and Zambia

“…Newer, highly portable digital CXR devices have been deployed in many high burden TB settings, improving access to medical imaging outside of regional hospitals, and CXRs may aid in the identification of individuals with communicable respiratory diseases including those at greater risk for worsening. (5),(6, 7) Such interventions may also be beneficial when future respiratory pandemics arise. Yet, the interpretation of CXR findings, especially in a setting where the caseload of patients with respiratory symptoms is high, requires novel strategies given variation in access to radiologists and expert readers.…”

Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities

“…In established clinical practice, the presence of chest X-ray (CXR) abnormalities provides radiological confirmation of pneumonia [ 8 ], which is also an independent risk factor for adverse clinical outcomes in COVID-19 patients [ 9 , 10 , 11 , 12 ]. Whilst CXR findings such as ground glass changes and consolidation are common in acute COVID-19 patients, a significant proportion of patients can also present with normal CXRs [ 10 , 13 , 14 ].…”