Brixia Chest X-ray Score, Laboratory Parameters and Vaccination Status for Prediction of Mortality in COVID-19 Hospitalized Patients (original) (raw)
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Journal of Nepal Medical Association
Introduction: COVID-19 is a highly contagious viral disease which escalated into a global pandemic since its outbreak on 31 December 2019. Chest X-rays are the most common investigation in suspected cases to diagnose and manage pneumonia. The aim of this study was to find out the mean Brixia severity scores among symptomatic COVID-19 patients in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the chest X-rays of symptomatic COVID-19-positive patients of a tertiary care centre. Data from 1 May 2021 to 31 July 2021 were collected between 1 August 2022 and 1 January 2023 from the hospital records. Ethical approval was taken from Institutional Review Committee (Reference number: 01-079/080). Patients with reverse transcriptase polymerase chain reaction with symptoms of COVID-19 were included in this study. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among the total of 300 patients, th...
Global Medical & Health Communication (GMHC)
On March 11, 2020, the World Health Organization declared the COVID-19 pandemic. This disease damages the lung and resulting mild to severe pneumonia. This study aimed to determine the value of the Brixia score for predicting mortality and length of stay of COVID-19 confirmed patients. The study design was case-control with secondary data from digital medical records of COVID-19 confirmed patients (December 2020 to February 2021). All patients' chest x-rays (CXR) were scored using the Brixia score. Logistic regression and the Spearman rank correlation test were used to identify mortality and length of stay predictors. There were 636 subjects included in this study, with the proportion of deceased patients (case group) being 20.3% (95% CI=17.33, 23.59%). Most CXR findings had signs of pneumonia (95.1%), including ground-glass opacities (GGOs) mixed with consolidation. The distribution of GGOs and consolidation were most frequent in the peripheral of survived patients (83.9%), whi...
Which role for chest x-ray score in predicting the outcome in COVID-19 pneumonia?
European Radiology
Objective We aim to demonstrate that a chest X-ray (CXR) scoring system for COVID-19 patients correlates with patient outcome and has a prognostic value. Methods This retrospective study included CXRs of COVID-19 patients that reported the Brixia score, a semi-quantitative scoring system rating lung involvement from 0 to 18. The highest (H) and lowest (L) values were registered along with scores on admission (A) and end of hospitalization (E). The Brixia score was correlated with the outcome (death or discharge). Results A total of 953 patients met inclusion criteria. In total, 677/953 were discharged and 276/953 died during hospitalization. A total of 524/953 had one CXR and 429/953 had more than one CXR. H-score was significantly higher in deceased (median, 12; IQR 9–14) compared to that in discharged patients (median, 8; IQR 5–11) (p < 0.0001). In 429/953 patients with multiple CXR, A-score, L-score, and E-score were higher in deceased than in discharged patients (A-score 9 vs...
International Journal of General Medicine
Introduction: The management of COVID-19 patients requires efficiency and accuracy in methods of detection, identification, monitoring, and treatment feasible in every hospital. Aside from clinical presentations and laboratory markers, chest x-ray imaging could also detect pneumonia caused by COVID-19. It is also a fast, simple, cheap, and safe modality used for the management of COVID-19 patients. Established scoring systems of COVID-19 chest x-ray imaging include Radiographic Assessment of Lung Edema (RALE) and Brixia classification. A modified scoring system has been adopted from BRIXIA and RALE scoring systems and has been made to adjust the scoring system needs at Dr. Soetomo General Hospital, Indonesia. This study aims to determine the value of scoring systems through chest x-ray imaging in evaluating the severity of COVID-19. Methods: Data were collected from May to June of 2020 who underwent chest x-ray evaluation. Each image is then scored using three types of classifications: modified score, RALE score, and Brixia score. The scores are then analyzed and compared with the clinical conditions and laboratory markers to determine their value in evaluating the severity of COVID-19 infection in patients. Results: A total of 115 patients were males (51.1%) and 110 were females (48.9%). All three scoring systems are significantly correlated with the clinical severity of the disease, with the strengths of correlation in order from the strongest to weakest as Brixia score (p<0.01, correlation coefficient 0.232), RALE score (p<0.01, correlation coefficient 0.209), and Dr. Soetomo General Hospital score (p<0.01, correlation coefficient 0.194). All three scoring systems correlate significantly with each other. Dr. Soetomo General Hospital score correlates more towards Brixia score (p<0.01, correlation coefficient 0.865) than RALE score (p<0.01, correlation coefficient 0.855). Brixia to RALE score correlates with a coefficient of 0.857 (p<0.01). Conclusion: The modified scoring system can help determine the severity of the disease progression in COVID-19 patients especially in areas with shortages of facilities and specialists.
Cureus, 2022
Background Through the coronavirus disease 2019 (COVID-19) pandemic, portable radiography was particularly useful for assessing and monitoring the COVID-19 disease in Vietnamese field hospitals. It provides a convenient and precise picture of the progression of the disease. The purpose of this study was to evaluate the predictive value of chest radiograph reporting systems (Brixia and total severity score (TSS)) and the National Early Warning Score (NEWS) clinical score in a group of hospitalized patients with COVID-19. Methods This retrospective cohort study used routinely collected clinical data from polymerase chain reaction (PCR)positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients admitted to Field Hospital District 8, Ho Chi Minh City, Vietnam, from August 2021 to September 2021. The initial chest radiographs were scored based on the TSS and Brixia scoring systems to quantify the extent of lung involvement. After the chest radiograph score was reported, two residents calculated the rate of all-cause in-hospital mortality with the consultation of expert radiologists. In this study, NEWS2 scores on hospital admission were calculated. The gradient boosting machines (GBMs) and Shapley additive exPlanations (SHAP) were applied to access the important variable and improve the accuracy of mortality prediction. The adjusted odds ratio for predictor was presented by univariate analysis and multivariate analysis. Results The chest X-rays (CXRs) at the admission of 273 patients (mean age 59 years +/-16, 42.1% were male) were scored. In the univariate analysis, age, vaccination status, previous disease, NEWS2, a saturation of peripheral oxygen (Sp02), the Brixia and TSS scores were significant predictors of mortality (p-value < 0.05). In multivariate analysis, there were statistically significant differences in mortality between age, Sp02, Brixia score, and patients with previous diseases were independent predictors of mortality and hospitalization. A gradient boosting machine was performed in the train data set, which showed that the best hyperparameters for predicting the mortality of patients are the Brixia score (exclude TSS score). In the top five predictors, an increase in Brixia, age, and BMI increased the logarithmic number of probability clarifying as death status. Although the TSS and Brixia scores evaluated chest imaging, the TSS score was not essential as the Brixia score (rank 6/11). It was clear that the BMI and NEWS2 score was positively correlated with the Brixia score, and age did not affect this correlation. Meanwhile, we did not find any trend between the TSS score versus BMI and NEWS2. Conclusion When integrated with the BMI and NEWS2 clinical classification systems, the severity score of COVID-19 chest radiographs, particularly the Brixia score, was an excellent predictor of all-cause in-hospital mortality.
Journal of Clinical Medicine
We aimed to investigate the performance of a chest X-ray (CXR) scoring scale of lung injury in prediction of death and ICU admission among patients with COVID-19 during the 2021 peak pandemic in HCM City, Vietnam. CXR and clinical data were collected from Vinmec Central Park-hospitalized patients from July to September 2021. Three radiologists independently assessed the day-one CXR score consisting of both severity and extent of lung lesions (maximum score = 24). Among 219 included patients, 28 died and 34 were admitted to the ICU. There was a high consensus for CXR scoring among radiologists (κ = 0.90; CI95%: 0.89–0.92). CXR score was the strongest predictor of mortality (tdAUC 0.85 CI95% 0.69–1) within the first 3 weeks after admission. A multivariate model confirmed a significant effect of an increased CXR score on mortality risk (HR = 1.33, CI95%: 1.10 to 1.62). At a threshold of 16 points, the CXR score allowed for predicting in-hospital mortality and ICU admission with good se...
European Radiology, 2020
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 par...
Jurnal Riset Kesehatan
The COVID-19 pandemic has put intense pressure on the healthcare systems. As the lung complication of COVID-19, pneumonia can be assessed by chest radiography which can be used to predict the severity of patient deterioration using Brixia and RALE scores. This research aims to assess the Radiologists' agreement on diagnosing pneumonia COVID-19 by RT-PCR in CXR using the Brixia and RALE score at Dr. Sardjito Central General Hospital from May 2020-January 2021. Two separate radiologists scored initial chest radiographs for RALE and Brixia independently. The analysis assessed included a descriptive analysis of demographic data, and Bland-Altman plots were used to visualize intra-observer agreement. A total of 332 samples were 162 men (48.8%) and 170 women (51.2%), with a mean age of 42.37. The ICC of Brixia score (0.855, CI:0.794-0.895) and RALE score (0.756, CI:0.662-0.812). Bland–Altman analysis revealed a bias of 5.08 ± 6.04 (95% limits of agreement of -6.760 and 16.929) for B...
Journal of the Faculty of Medicine Baghdad
Background: The radiological scoring of severity and progression of lung abnormalities is of great value for clinicians to define the clinical management of COVID-19 patients. Objectives: The purpose of this study is to implement the Brixia scoring tool to assess the pattern of lung involvement in patients with COVID-19 to help predict the severity of their clinical outcome, where the clinical outcome correlates to outpatient, inpatient and/or ICU admission. Patients and Methods: We conducted a case series study at the Sheikh Khalifa Medical City Ajman (SKMCA), United Arab Emirates from 14 March to 30 October 2020. Patients’ medical records were reviewed and followed up from the time of diagnosis until discharge and/or death. The patients were included based on the following criteria: Confirmed COVID-19 infection via RT-PCR assay, symptoms of COVID-19 within one week prior to presenting at the hospital and an initial Chest X-ray at hospital presentation. Two independent and experien...