COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression

Abstract

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new virus recently isolated from humans. SARS-CoV-2 was discovered to be the pathogen responsible for a cluster of pneumonia cases associated with severe respiratory disease that occurred in December 2019 in China. This novel pulmonary infection, formally called Coronavirus Disease 2019 (COVID-19), has spread rapidly in China and beyond. On 8 March 2020, the number of Italians with SARS-CoV-2 infection was 7375 with a 48% hospitalization rate. At present, chest-computed tomography imaging is considered the most effective method for the detection of lung abnormalities in early-stage disease and quantitative assessment of severity and progression of COVID-19 pneumonia. Although chest X-ray (CXR) is considered not sensitive for the detection of pulmonary involvement in the early stage of the disease, we believe that, in the current emergency setting, CXR can be a useful diagnostic tool for monitoring the rapid progression of lung abnormalities in infected patients, particularly in intensive care units. In this short communication, we present our experimental CXR scoring system that we are applying to hospitalized patients with COVID-19 pneumonia to quantify and monitor the severity and progression of this new infectious disease. We also present the results of our preliminary validation study on a sample of 100 hospitalized patients with SARS-CoV-2 infection for whom the final outcome (recovery or death) was available.

Risk Factors of Fatal Outcome in Patients With COVID-19 Pneumonia

“…In our study a significant correlation was found between a fatal outcome and the CXR severity score: a similar result was obtained in a retrospective study on 100 hospitalized patients with COVID-19 infection by Borghesi et al, in which the quantitative analysis of chest X-Ray, based on the type of lung abnormalities, significantly correlated with the final outcome, with severity score higher (p≤.002) in patients who died than those discharged [29].…”

Radiographic severity index in COVID-19 pneumonia: relationship to age and sex in 783 Italian patients

“…Our CXR scoring system, the first designed specifically for COVID-19 pneumonia, is a very useful method for ranking the risk stratification of patients with SARS-CoV-2 infection [10]. It allows to easily and quickly obtain a severity index of lung abnormalities [10]. In addition, it provides relevant information on lung disease in an extremely clear way by channeling the available resources toward the maximal amount of benefits.…”

“…Given the mortality rate of this disease [4,5], physicians should be aware of the potential risk factors associated with a fatal outcome [6][7][8][9]. To improve the risk stratification and aid clinicians in defining a "tailored" level of care for highrisk patients, an experimental chest X-ray (CXR) scoring system for quantifying the severity and progression of lung abnormalities in COVID-19 pneumonia was introduced in our Diagnostic Imaging Department [10]. This CXR scoring system (named Brixia score), designed exclusively for semi-quantitative assessment of lung disease in COVID-19, ranking the pulmonary involvement on an 18-point severity scale according to extent and characteristics of lung abnormalities (for more details, see Reference 10).…”

“…Considering the close relationship between pulmonary involvement and the risk of death [10], the purpose of this study was to retrospectively evaluate correlations between the CXR score and the age or sex of Italian patients infected with SARS-CoV-2.…”

The role of chest radiography in confirming covid-19 pneumonia

“…Other countries, including Italy and Spain, have not reported their approach to covid-19 imaging beyond occasional case series and reports 343536…”