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

Link to article at PubMed

Clin Med (Lond). 2021 Jan;21(1):e14-e19. doi: 10.7861/clinmed.2020-0576.


OBJECTIVE: 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.

DESIGN: The study was a retrospective case-controlled study.

PARTICIPANTS: There were 163 patients with COVID-19 deemed candidates for CPAP on admission, including 58 who subsequently required CPAP.

OUTCOME MEASURES: 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.

RESULTS: 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).

CONCLUSIONS: 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.

PMID:33479078 | DOI:10.7861/clinmed.2020-0576

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