Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department

Maurizio Balbi; Anna Caroli; Andrea Corsi; Gianluca Milanese; Alessandra Surace; Fabiano Di Marco; Luca Novelli; Mario Silva; Ferdinando Luca Lorini; Andrea Duca; Roberto Cosentini; Nicola Sverzellati; Pietro Andrea Bonaffini; Sandro Sironi

doi:10.1007/s00330-020-07270-1

Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department

Maurizio Balbi, Anna Caroli, Andrea Corsi, Gianluca Milanese, Alessandra Surace, Fabiano Di Marco, Luca Novelli, Mario Silva, Ferdinando Luca Lorini, Andrea Duca, Roberto Cosentini, Nicola Sverzellati, Pietro Andrea Bonaffini, Sandro Sironi

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support.

METHODS: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression.

RESULTS: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support.

CONCLUSIONS: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO2/FiO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support.

KEY POINTS: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO2/FIO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.

Original language	English
Journal	European Radiology
DOIs	https://doi.org/10.1007/s00330-020-07270-1
Publication status	E-pub ahead of print - Oct 8 2020

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Balbi, M., Caroli, A., Corsi, A., Milanese, G., Surace, A., Di Marco, F., Novelli, L., Silva, M., Lorini, F. L., Duca, A., Cosentini, R., Sverzellati, N., Bonaffini, P. A., & Sironi, S. (2020). Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department. European Radiology. https://doi.org/10.1007/s00330-020-07270-1

Balbi, M, Caroli, A, Corsi, A, Milanese, G, Surace, A, Di Marco, F, Novelli, L, Silva, M, Lorini, FL, Duca, A, Cosentini, R, Sverzellati, N, Bonaffini, PA & Sironi, S 2020, 'Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department', European Radiology. https://doi.org/10.1007/s00330-020-07270-1

@article{12350922a2b94233956161cdb3b4f119,

title = "Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department",

abstract = "OBJECTIVES: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support.METHODS: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression.RESULTS: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support.CONCLUSIONS: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO2/FiO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support.KEY POINTS: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO2/FIO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.",

author = "Maurizio Balbi and Anna Caroli and Andrea Corsi and Gianluca Milanese and Alessandra Surace and {Di Marco}, Fabiano and Luca Novelli and Mario Silva and Lorini, {Ferdinando Luca} and Andrea Duca and Roberto Cosentini and Nicola Sverzellati and Bonaffini, {Pietro Andrea} and Sandro Sironi",

year = "2020",

month = oct,

day = "8",

doi = "10.1007/s00330-020-07270-1",

language = "English",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

}

TY - JOUR

T1 - Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department

AU - Balbi, Maurizio

AU - Caroli, Anna

AU - Corsi, Andrea

AU - Milanese, Gianluca

AU - Surace, Alessandra

AU - Di Marco, Fabiano

AU - Novelli, Luca

AU - Silva, Mario

AU - Lorini, Ferdinando Luca

AU - Duca, Andrea

AU - Cosentini, Roberto

AU - Sverzellati, Nicola

AU - Bonaffini, Pietro Andrea

AU - Sironi, Sandro

PY - 2020/10/8

Y1 - 2020/10/8

N2 - OBJECTIVES: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support.METHODS: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression.RESULTS: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support.CONCLUSIONS: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO2/FiO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support.KEY POINTS: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO2/FIO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.

AB - OBJECTIVES: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support.METHODS: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression.RESULTS: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support.CONCLUSIONS: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO2/FiO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support.KEY POINTS: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO2/FIO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.

U2 - 10.1007/s00330-020-07270-1

DO - 10.1007/s00330-020-07270-1

M3 - Article

C2 - 33033861

SN - 0938-7994

JO - European Radiology

JF - European Radiology

ER -

Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department

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