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      Association between chest X-ray score and clinical outcome in COVID-19 patients: A study on modified radiographic assessment of lung edema score (mRALE) in Indonesia

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          Abstract

          Radiological examinations such as chest X-rays (CXR) play a crucial role in the early diagnosis and determining disease severity in coronavirus disease 2019 (COVID-19). Various CXR scoring systems have been developed to quantitively assess lung abnormalities in COVID-19 patients, including CXR modified radiographic assessment of lung edema (mRALE). The aim of this study was to determine the relationship between mRALE scores and clinical outcome (mortality), as well as to identify the correlation between mRALE score and the severity of hypoxia (PaO2/FiO2 ratio). A retrospective cohort study was conducted among hospitalized COVID-19 patients at Dr. Soetomo General Academic Hospital Surabaya, Indonesia, from February to April 2022. All CXR data at initial admission were scored using the mRALE scoring system, and the clinical outcomes at the end of hospitalization were recorded. Of the total 178 COVID-19 patients, 62.9% survived after completing the treatment. Patients within non-survived had significantly higher quick sequential organ failure assessment (qSOFA) score ( p<0.001), lower PaO2/FiO2 ratio ( p=0.004), and higher blood urea nitrogen ( p<0.001), serum creatinine ( p<0.008) and serum glutamic oxaloacetic transaminase ( p=0.001) levels. There was a significant relationship between mRALE score and clinical outcome (survived vs deceased) ( p=0.024; contingency coefficient of 0.184); and mRALE score of ≥2.5 served as a risk factor for mortality among COVID-19 patients (relative risk of 1.624). There was a significant negative correlation between the mRALE score and PaO 2/FiO 2 ratio based on the Spearman correlation test ( r=-0.346; p<0.001). The findings highlight that the initial mRALE score may serve as an independent predictor of mortality among hospitalized COVID-19 patients as well as proves its potential prognostic role in the management of COVID-19.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Fei Zhou, Ting Yu, Ronghui Du … (2020)
          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

            Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour … (2016)
            Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.
            Article 0 comments Cited 6211 times – based on 0 reviews     Review now
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              Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

              Vincent Liu, Christopher W Seymour, Derek C Angus … (2016)
              The Third International Consensus Definitions Task Force defined sepsis as "life-threatening organ dysfunction due to a dysregulated host response to infection." The performance of clinical criteria for this sepsis definition is unknown.
              Article 0 comments Cited 810 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Narra J
                Journal ID (iso-abbrev): Narra J
                Journal ID (publisher-id): NarraJ
                Title: Narra J
                Publisher: Narra Sains Indonesia
                ISSN (Electronic): 2807-2618
                Publication date (Print): April 2024
                Publication date (Electronic): 6 April 2024
                Volume: 4
                Issue: 1
                Electronic Location Identifier: e691
                Affiliations
                [1 ]Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga , Surabaya, Indonesia
                [2 ]Department of Internal Medicine, Dr. Soetomo General Academic Hospital , Surabaya, Indonesia
                [3 ]Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga , Surabaya, Indonesia
                [4 ]Division of Tropical Medicine and Infectious Disease, Dr. Soetomo General Academic Hospital , Surabaya, Indonesia
                [5 ]Department of Radiology, Faculty of Medicine, Universitas Airlangga , Surabaya, Indonesia
                [6 ]Department of Radiology, Dr. Soetomo General Academic Hospital , Surabaya, Indonesia
                Author notes
                [* ]Corresponding author: drpujirahayu.drpr@ 123456gmail.com
                Article
                Publisher ID: NarraJ-4-e691
                DOI: 10.52225/narra.v4i1.691
                PMC ID: 11125424
                PubMed ID: 38798849
                SO-VID: 06747ece-e27c-4ac1-baf3-7d54b9c65b6e
                Copyright © © 2024 by the authors.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY NC 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited ( https://creativecommons.org/licenses/by-nc/4.0/).

                History
                Date received : 29 January 2024
                Date accepted : 3 April 2024
                Categories
                Subject: Original Article

                Keywords: clinical outcome,cxr scoring system,mrale score,severity,hypoxia
                Data availability:
                Keywords: clinical outcome, cxr scoring system, mrale score, severity, hypoxia

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