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The association of chest radiographic findings and severity scoring with clinical outcomes in patients with COVID-19 presenting to the emergency department of a tertiary care hospital in Pakistan.
Kaleemi, Raima; Hilal, Kiran; Arshad, Ainan; Martins, Russell Seth; Nankani, Avinash; Tu, Haq; Basharat, Sundas; Ansar, Zeeshan.
  • Kaleemi R; Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.
  • Hilal K; Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.
  • Arshad A; Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
  • Martins RS; Medical College, Aga Khan University Hospital, Karachi, Pakistan.
  • Nankani A; Research and Development Wing, Society for Promoting Innovation in Education, Karachi, Pakistan.
  • Tu H; Research and Development Wing, Society for Promoting Innovation in Education, Karachi, Pakistan.
  • Basharat S; Dow University of Health Sciences, Karachi, Pakistan.
  • Ansar Z; Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.
PLoS One ; 16(1): e0244886, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1059976
ABSTRACT

INTRODUCTION:

While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19.

METHODS:

All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0-8 was used to quantify the extent of pulmonary infection on CXR, with a score of 0 being negative and 1-8 being positive. The patients' initial CXR-SS and their highest CXR-SS over the hospital course were used for analysis, with cut-offs of 0-4 and 5-8 being used to assess association with clinical outcomes.

RESULTS:

A total of 150 patients, with 76.7% males and mean age 56.1 years, were included in this study. Initial CXR was positive in 80% of patients, and 30.7% of patients had an initial CXR-SS between 5-8. The mortality rate was 16.7% and 30.6% patients underwent ICU admission with intubation (ICU-Int). On multivariable analysis, initial CXR-SS (1.355 [1.136-1.616]) and highest CXR-SS (1.390 [1.143-1.690]) were predictors of ICU-Int, and ICU-Int was independently associated with both initial CXR-SS 5-8 (2.532 [1.109-5.782]) and highest CXR-SS 5-8 (3.386 [1.405-8.159]). Lastly, age (1.060 [1.009-1.113]), initial CXR-SS (1.278 [1.010-1.617]) and ICU-Int (5.047 [1.731-14.710]), were found to be independent predictors of mortality in our patients.

CONCLUSION:

In a resource-constrained country like Pakistan, CXRs may have valuable prognostic utility in predicting ICU admission and mortality. Additional research with larger patient samples is needed to further explore the association of CXR findings with clinical outcomes.
Asunto(s)

Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Radiografía Torácica / COVID-19 / Pulmón Tipo de estudio: Estudio observacional / Estudio pronóstico Límite: Adulto / Anciano / Femenino / Humanos / Masculino / Middle aged País/Región como asunto: Asia Idioma: Inglés Revista: PLoS One Asunto de la revista: Ciencia / Medicina Año: 2021 Tipo del documento: Artículo País de afiliación: Journal.pone.0244886

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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Radiografía Torácica / COVID-19 / Pulmón Tipo de estudio: Estudio observacional / Estudio pronóstico Límite: Adulto / Anciano / Femenino / Humanos / Masculino / Middle aged País/Región como asunto: Asia Idioma: Inglés Revista: PLoS One Asunto de la revista: Ciencia / Medicina Año: 2021 Tipo del documento: Artículo País de afiliación: Journal.pone.0244886