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

Narra J Pub Date : 2024-04-06 DOI:10.52225/narra.v4i1.691

Dwi RP. Rahayu, M. Rusli, Bramantono Bramantono, Anita Widyoningroem

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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 PaO2/FiO2 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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COVID-19患者胸部X光评分与临床结果之间的关系：印度尼西亚肺水肿改良放射学评估评分（mRALE）研究

胸部 X 光（CXR）等放射学检查在 2019 年冠状病毒病（COVID-19）的早期诊断和确定疾病严重程度方面发挥着至关重要的作用。目前已开发出多种 CXR 评分系统来量化评估 COVID-19 患者的肺部异常情况，包括 CXR 肺水肿改良放射学评估（mRALE）。本研究旨在确定 mRALE 评分与临床结果（死亡率）之间的关系，以及 mRALE 评分与缺氧严重程度（PaO2/FiO2 比值）之间的相关性。2022 年 2 月至 4 月，印度尼西亚泗水苏托莫博士综合学术医院对 COVID-19 住院患者进行了一项回顾性队列研究。研究人员使用mRALE评分系统对患者入院时的所有CXR数据进行评分，并记录了住院结束时的临床结果。在178名COVID-19患者中，62.9%的患者在完成治疗后存活。未存活患者的快速序贯器官衰竭评估（qSOFA）评分明显更高（p<0.001），PaO2/FiO2比值更低（p=0.004），血尿素氮（p<0.001）、血清肌酐（p<0.008）和血清谷草转氨酶（p=0.001）水平更高。mRALE 评分与临床结果（存活与死亡）之间存在明显关系（p=0.024；或然系数为 0.184）；mRALE 评分≥2.5 是 COVID-19 患者死亡的风险因素（相对风险为 1.624）。根据斯皮尔曼相关性检验，mRALE 评分与 PaO2/FiO2 比率之间存在明显的负相关（r=-0.346；p<0.001）。研究结果表明，初始 mRALE 评分可作为 COVID-19 住院患者死亡率的独立预测指标，并证明了其在 COVID-19 治疗中的潜在预后作用。

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Narra J

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