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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.
PLoS One. 2021; 16(1):e0244886.Plos

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.

Authors+Show Affiliations

Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.Medical College, Aga Khan University Hospital, Karachi, Pakistan. Research and Development Wing, Society for Promoting Innovation in Education, Karachi, Pakistan.Research and Development Wing, Society for Promoting Innovation in Education, Karachi, Pakistan. Dow University of Health Sciences, Karachi, Pakistan.Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.Microbiology Department, Aga Khan University Hospital, Karachi, Pakistan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33400723

Citation

Kaleemi, Raima, et al. "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." PloS One, vol. 16, no. 1, 2021, pp. e0244886.
Kaleemi R, Hilal K, Arshad A, et al. 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. PLoS One. 2021;16(1):e0244886.
Kaleemi, R., Hilal, K., Arshad, A., Martins, R. S., Nankani, A., Tu, H., Basharat, S., & Ansar, Z. (2021). 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. PloS One, 16(1), e0244886. https://doi.org/10.1371/journal.pone.0244886
Kaleemi R, et al. 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. PLoS One. 2021;16(1):e0244886. PubMed PMID: 33400723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Kaleemi,Raima, AU - Hilal,Kiran, AU - Arshad,Ainan, AU - Martins,Russell Seth, AU - Nankani,Avinash, AU - Tu,Haq, AU - Basharat,Sundas, AU - Ansar,Zeeshan, Y1 - 2021/01/05/ PY - 2020/08/06/received PY - 2020/12/17/accepted PY - 2021/1/5/entrez PY - 2021/1/6/pubmed PY - 2021/1/15/medline SP - e0244886 EP - e0244886 JF - PloS one JO - PLoS One VL - 16 IS - 1 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/33400723/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_ L2 - https://dx.plos.org/10.1371/journal.pone.0244886 DB - PRIME DP - Unbound Medicine ER -