The prognostic value of chest X-ray in patients with COVID-19 on admission and when starting CPAP

• Published in: Clinical medicine (London, England) England), 2021-01, Vol.21 (1), p.e14-e19
• Main Authors: Sargent, Will, Ali, Sajeed, Kukran, Sebi, Harvie, Miranda, Soin, Susanne
• Format: Article
• Language: English
• Subjects: acute medicine; Blood tests; chest X-ray; Continuous positive airway pressure; Coronaviruses; COVID-19; CPAP; Diabetes; Ethnicity; Hypertension; Intubation; Original Research; Patients; radiology; Severe acute respiratory syndrome coronavirus 2; Ventilators; X-rays
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmed.2020-0576

The objective was to explore if chest X-ray severity, assessed using a validated scoring system, predicts patient outcome on admission and when starting continuous positive pressure ventilation (CPAP) for COVID-19. The study was a retrospective case-controlled study. There were 163 patients with COVID-19 deemed candidates for CPAP on admission, including 58 who subsequently required CPAP. On admission, we measured the proportion of patients meeting a composite ‘negative’ outcome of requiring CPAP, intubation or dying versus successful ward-based care. For those escalated to CPAP, ‘negative’ outcomes were intubation or death versus successful de-escalation of respiratory support. Our results were stratified into tertiles, those with ‘moderate’ or ‘severe’ X-rays on admission had significantly higher odds of negative outcome versus ‘mild’ (odds ratio (OR) 2.32; 95% confidence interval (CI) 1.121–4.803; p=0.023; and OR 3.600; 95% CI 1.681–7.708; p=0.001, respectively). This could not be demonstrated in those commencing CPAP (OR 0.976; 95% CI 0.754–1.264; p=0.856). We outline a scoring system to stratify X-rays by severity and directly link this to prognosis. However, we were unable to demonstrate this association in the patients commencing CPAP.