Radiographic Assessment of Lung Edema (RALE) Scores are Highly Reproducible and Prognostic of Clinical Outcomes for Inpatients with COVID-19

Al-Yousif, Nameer; Komanduri, Saketram; Qurashi, H.M.S.; Korzhuk, Anatoliy; Lawal, Halimat; 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, A.; Girard, C.; Gillenwater, S.; Hadeh, Anas; Bain, William; Shah, Faraaz; Bittner, Matthew; Lu, Michael; Prendergast, N.; Evankovich, John; Golubykh, K.; Ramesh, N.; Jacobs, Jana J; Kessinger, Cathy; Methé, Barbara A.; Lee, Janet; Morris, Alison; McVerry, Bryan J.; Kitsios, Georgios D

doi:10.1101/2022.06.10.22276249

Cited by 6 publications

(10 citation statements)

References 27 publications

(34 reference statements)

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“…In subgroups of ARDS patients, we did not find associations between ARDS subgroups and our primary outcome, 30-day mortality, but did find an association between the baseline RALE score and 90-day mortality in non-COVID-ARDS patients only. These conflicting results are in line with previous literature, as most studies found no associations [ 8 , 9 , 10 , 11 ], whereas the original [ 5 ] and another study [ 7 ] did find an association between baseline RALE scores and mortality in ARDS patients. These inconsistent findings in ARDS studies might be caused by the heterogeneous ARDS population, the different inclusion and exclusion criteria or the timing of the CXRs [ 5 , 7 , 8 , 9 , 10 , 11 ].…”

Section: Discussionsupporting

confidence: 77%

“…Pulmonary edema typically results in ventilation-perfusion mismatch, and subsequent hypoxemia may require ventilation with higher pressures due to decreased compliance of the lung [ 1 ]. At hospital presentation, baseline RALE scores demonstrated an association with ICU admission and mortality [ 11 , 12 , 13 , 14 , 15 ]. In the ICU, ARDS patients with higher baseline RALE scores, indicating more radiographic lung edema, were found to have a higher mortality in one study [ 5 ], although other studies found stronger associations between the change in RALE score and mortality [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients

Filippini

Hagens

Heijnen

et al. 2023

JCM

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Introduction: The Radiographic Assessment of Lung Edema (RALE) score provides a semi-quantitative measure of pulmonary edema. In patients with acute respiratory distress syndrome (ARDS), the RALE score is associated with mortality. In mechanically ventilated patients in the intensive care unit (ICU) with respiratory failure not due to ARDS, a variable degree of lung edema is observed as well. We aimed to evaluate the prognostic value of RALE in mechanically ventilated ICU patients. Methods: Secondary analysis of patients enrolled in the ‘Diagnosis of Acute Respiratory Distress Syndrome’ (DARTS) project with an available chest X-ray (CXR) at baseline. Where present, additional CXRs at day 1 were analysed. The primary endpoint was 30-day mortality. Outcomes were also stratified for ARDS subgroups (no ARDS, non-COVID-ARDS and COVID-ARDS). Results: 422 patients were included, of which 84 had an additional CXR the following day. Baseline RALE scores were not associated with 30-day mortality in the entire cohort (OR: 1.01, 95% CI: 0.98–1.03, p = 0.66), nor in subgroups of ARDS patients. Early changes in RALE score (baseline to day 1) were only associated with mortality in a subgroup of ARDS patients (OR: 1.21, 95% CI: 1.02–1.51, p = 0.04), after correcting for other known prognostic factors. Conclusions: The prognostic value of the RALE score cannot be extended to mechanically ventilated ICU patients in general. Only in ARDS patients, early changes in RALE score were associated with mortality.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients

Filippini

Hagens

Heijnen

et al. 2023

JCM

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“… 10 Our study focused on using CSS, a simple and reliable scoring system when compared to other widely studied scoring systems like Radiographic assessment of lung edema (RALE/modified RALE) and Brixia. 27. , 28.…”

Section: Discussionmentioning

confidence: 99%

Utility of chest radiograph severity scoring in emergency department for predicting outcomes in COVID-19: A study of 1275 patients

Venugopalan

Kumar²,

McInnes³

et al. 2023

Clinical Imaging

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“…b. The COVID INpatient Cohort (COVID-INC) enrolled moderately ill inpatients with COVID-19 hospitalized in dedicated inpatient wards [11].…”

Section: Clinical Cohortsmentioning

confidence: 99%

Trajectories of host-response biomarkers and inflammatory subphenotypes in COVID-19 patients across the spectrum of respiratory support

Drohan

Bain

et al. 2022

Preprint

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Purpose: Enhanced understanding of the dynamic changes in the dysregulated inflammatory response in COVID-19 may help improve patient selection and timing for immunomodulatory therapies. Methods: We enrolled 323 COVID-19 inpatients on different levels of baseline respiratory support: i) Low Flow Oxygen (37%), ii) Non-Invasive Ventilation or High Flow Oxygen (NIV_HFO, 29%), iii) Invasive Mechanical Ventilation (IMV, 27%), and iv) Extracorporeal Membrane Oxygenation (ECMO, 7%). We collected plasma samples upon enrollment and days 5 and 10 to measure host-response biomarkers. We classified subjects into inflammatory subphenotypes using two validated predictive models. We examined clinical, biomarker and subphenotype trajectories and outcomes during hospitalization. Results: IL-6, procalcitonin, and Angiopoietin-2 were persistently elevated in patients at higher levels of respiratory support, whereas sRAGE displayed the inverse pattern. Patients on NIV_HFO at baseline had the most dynamic clinical trajectory, with 26% eventually requiring intubation and exhibiting worse 60-day mortality than IMV patients at baseline (67% vs. 35%, p<0.0001). sRAGE levels predicted NIV failure and worse 60-day mortality for NIV_HFO patients, whereas IL-6 levels were predictive in IMV or ECMO patients. Hyper-inflammatory subjects at baseline (<10% by both models) had worse 60-day survival (p<0.0001) and 50% of them remained classified as hyper-inflammatory on follow-up sampling at 5 days post-enrollment. Receipt of combined immunomodulatory therapies (steroids and anti-IL6 agents) was associated with markedly increased IL-6 and lower Angiopoietin-2 levels (p<0.05). Conclusions: Longitudinal study of systemic host responses in COVID-19 revealed substantial and predictive inter-individual variability, influenced by baseline levels of respiratory support and concurrent immunomodulatory therapies.

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Radiographic Assessment of Lung Edema (RALE) Scores are Highly Reproducible and Prognostic of Clinical Outcomes for Inpatients with COVID-19

Cited by 6 publications

References 27 publications

Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients

Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients

Utility of chest radiograph severity scoring in emergency department for predicting outcomes in COVID-19: A study of 1275 patients

Trajectories of host-response biomarkers and inflammatory subphenotypes in COVID-19 patients across the spectrum of respiratory support

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