Role of a Chest X-ray Severity Score in a Multivariable Predictive Model for Mortality in Patients with COVID-19: A Single-Center, Retrospective Study

Masoud Baikpour, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Alex Carlos, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Ryan Morasse, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Hannah Gissel, Department of Interventional Radiology, George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA.
Victor Perez-Gutierrez, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Jessica Nino, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Jose Amaya-Suarez, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Fatimatu Ali, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Talya Toledano, Department of Radiology, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Joseph Arampulikan, Department of Radiology, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Menachem Gold, Department of Radiology, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Usha Venugopal, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Anjana Pillai, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Kennedy Omonuwa, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.
Vidya Menon, Department of Medicine, NYC Health and Hospitals/Lincoln, 234 East 149th Street, Bronx, NY 10451, USA.

Document Type

Journal Article

Publication Date

4-12-2022

Journal

Journal of clinical medicine

Volume

11

Issue

8

DOI

10.3390/jcm11082157

Keywords

COVID-19; chest X-ray; mortality; predictive model; severity score

Abstract

Predicting the mortality risk of patients with Coronavirus Disease 2019 (COVID-19) can be valuable in allocating limited medical resources in the setting of outbreaks. This study assessed the role of a chest X-ray (CXR) scoring system in a multivariable model in predicting the mortality of COVID-19 patients by performing a single-center, retrospective, observational study including consecutive patients admitted with a confirmed diagnosis of COVID-19 and an initial CXR. The CXR severity score was calculated by three radiologists with 12 to 15 years of experience in thoracic imaging, based on the extent of lung involvement and density of lung opacities. Logistic regression analysis was used to identify independent predictive factors for mortality to create a predictive model. A validation dataset was used to calculate its predictive value as the AUROC. A total of 628 patients (58.1% male) were included in this study. Age ( < 0.001), sepsis ( < 0.001), S/F ratio ( < 0.001), need for mechanical ventilation ( < 0.001), and the CXR severity score ( = 0.005) were found to be independent predictive factors for mortality. We used these variables to develop a predictive model with an AUROC of 0.926 (0.891, 0.962), which was significantly higher than that of the WHO COVID severity classification, 0.853 (0.798, 0.909) (one-tailed -value = 0.028), showing that our model can accurately predict mortality of hospitalized COVID-19 patients.

Department

School of Medicine and Health Sciences Resident Works

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