Chest Radiography Features Help to Predict a Favorable Outcome in Patients with Coronavirus Disease 2019.

Editor:

It was with great interest that we read the study by Dr Toussie and colleagues, published in Radiology online on May 14, 2020 (1). In this retrospective study of 338 patients aged 21–50 years with confirmed reverse transcriptase–polymerase chain reaction (RT-PCR) coronavirus disease 2019 (COVID-19) diagnosis, a chest radiography severity score was assigned, dividing the lungs into three zones according to the presence (score of 1) or absence (score of 0) of opacity in each zone. Chest radiography score of 3 or greater proved to be an independent predictor of intubation.

In this regard, we would like to present some interesting data from our institution in Milan (Italy) that could cast new light on this topic.

We retrospectively assessed the prognostic value of chest radiography performed at initial presentation in a series of patients with diagnosis-confirmed RT-PCR COVID-19 by using the chest radiography severity score proposed by Dr Wong and colleagues (2). This classification depends on the extent of involvement by consolidation or ground-glass opacities (GGOs) (score of 0, no involvement; 1, <25%; 2, 25%–50%; 3, 50%–75%; 4, ≥75% involvement), with a maximum score of 8.

Two experienced cardiothoracic radiologists (M.C., with 10 years of experience, and G.O., with 25 years of experience) assessed the presence of GGO and consolidation (3), and independently assigned the severity score. Demographic data, comorbidities, and symptoms at arrival were collected. The primary outcome of interest for this study was a mild disease course, defined by no need for hospitalization or hospitalization duration less than 4 days, without any form of assisted ventilation. The relationship between the outcome with chest radiography severity score, radiologic features, and demographic and clinical parameters was investigated by fitting a logistic regression model. We enrolled 246 patients (170 male patients; age range, 30–95 years; mean age, 63 years ± 16 [standard deviation]). Interobserver agreement was excellent, with Cohen κ coefficient of 0.9. Independent predictors with statistically significant inverse correlation with mild outcome were as follows: age (odds ratio [OR], 0.92; 95% confidence interval [CI]: 0.88, 0.95; P < .001), chest radiography severity score of 3 or greater (OR, 0.24; 95% CI: 0.69, 0.81; P < .001), and presence of GGOs (OR, 3.79; 95% CI: 0.12, 11.98; P < .02). Sex was correlated with the outcome, with favorable outcome in female patients (OR, 0.05; 95% CI: 0.01, 0.22; P < .001). Our results support the role of chest radiography as a first-line triage tool in detecting COVID-19 pneumonia.

We congratulate Dr Toussie and colleagues for their article and for striving to optimize treatment of patients with COVID-19.