Initial chest radiographs and artificial intelligence (AI) predict clinical outcomes in COVID-19 patients: analysis of 697 Italian patients.
Eur Radiol
; 31(3): 1770-1779, 2021 Mar.
Article
in English
| MEDLINE | ID: covidwho-777788
ABSTRACT
OBJECTIVE:
To evaluate whether the initial chest X-ray (CXR) severity assessed by an AI system may have prognostic utility in patients with COVID-19.METHODS:
This retrospective single-center study included adult patients presenting to the emergency department (ED) between February 25 and April 9, 2020, with SARS-CoV-2 infection confirmed on real-time reverse transcriptase polymerase chain reaction (RT-PCR). Initial CXRs obtained on ED presentation were evaluated by a deep learning artificial intelligence (AI) system and compared with the Radiographic Assessment of Lung Edema (RALE) score, calculated by two experienced radiologists. Death and critical COVID-19 (admission to intensive care unit (ICU) or deaths occurring before ICU admission) were identified as clinical outcomes. Independent predictors of adverse outcomes were evaluated by multivariate analyses.RESULTS:
Six hundred ninety-seven 697 patients were included in the study 465 males (66.7%), median age of 62 years (IQR 52-75). Multivariate analyses adjusting for demographics and comorbidities showed that an AI system-based score ≥ 30 on the initial CXR was an independent predictor both for mortality (HR 2.60 (95% CI 1.69 - 3.99; p < 0.001)) and critical COVID-19 (HR 3.40 (95% CI 2.35-4.94; p < 0.001)). Other independent predictors were RALE score, older age, male sex, coronary artery disease, COPD, and neurodegenerative disease.CONCLUSION:
AI- and radiologist-assessed disease severity scores on CXRs obtained on ED presentation were independent and comparable predictors of adverse outcomes in patients with COVID-19. TRIAL REGISTRATION ClinicalTrials.gov NCT04318366 ( https//clinicaltrials.gov/ct2/show/NCT04318366 ). KEY POINTS ⢠AI system-based score ≥ 30 and a RALE score ≥ 12 at CXRs performed at ED presentation are independent and comparable predictors of death and/or ICU admission in COVID-19 patients. ⢠Other independent predictors are older age, male sex, coronary artery disease, COPD, and neurodegenerative disease. ⢠The comparable performance of the AI system in relation to a radiologist-assessed score in predicting adverse outcomes may represent a game-changer in resource-constrained settings.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Radiography, Thoracic
/
Deep Learning
/
COVID-19
/
Intensive Care Units
Type of study:
Diagnostic study
/
Experimental Studies
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Observational study
/
Prognostic study
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Randomized controlled trials
Limits:
Aged
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Female
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Humans
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Male
/
Middle aged
Country/Region as subject:
Europa
Language:
English
Journal:
Eur Radiol
Journal subject:
Radiology
Year:
2021
Document Type:
Article
Affiliation country:
S00330-020-07269-8
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