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. 2020 Sep 16;9(9):2990.
doi: 10.3390/jcm9092990.

Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19

Elisabetta Cocconcelli  1 , Davide Biondini  1 , Chiara Giraudo  2 , Sara Lococo  1 , Nicol Bernardinello  1 , Giulia Fichera  2 , Giulio Barbiero  2 , Gioele Castelli  3 , Silvia Cavinato  4 , Anna Ferrari  4 , Marina Saetta  1 , Annamaria Cattelan  4 , Paolo Spagnolo  1 , Elisabetta Balestro  1
Affiliations

Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19

Elisabetta Cocconcelli et al. J Clin Med. .

Abstract

Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic with lung disease representing the main cause of morbidity and mortality. Conventional chest-X ray (CXR) and ultrasound (US) are valuable instruments to assess the extent of lung involvement. We investigated the relationship between CXR scores on admission and the level of medical care required in patients with COVID-19. Further, we assessed the CXR-US correlation to explore the role of ultrasound in monitoring the course of COVID-19 pneumonia. Clinical features and CXR scores were obtained at admission and correlated with the level of intensity of care required [high- (HIMC) versus low-intensity medical care (LIMC)]. In a subgroup of patients, US findings were correlated with clinical and radiographic parameters. On hospital admission, CXR global score was higher in HIMCs compared to LIMC. Smoking history, pO2 on admission, cardiovascular and oncologic diseases were independent predictors of HIMC. The US score was positively correlated with FiO2 while the correlation with CXR global score only trended towards significance. Our study identifies clinical and radiographic features that strongly correlate with higher levels of medical care. The role of lung ultrasound in this setting remains undetermined and needs to be explored in larger prospective studies.

Keywords: COVID-19; chest X-ray; outcome of severity; ultrasound.

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Conflict of interest statement

P.S. has received personal fees and non-financial support from Roche, Boehringer-Ingelheim, Zambon, and PPM Services. E.B. has received personal fees from Roche and Boehringer-Ingelheim. M.S. has received research grants for the Department (not personal) to her Institution from Takeda Ltd., Chiesi Farmaceutici and Laboratori Guidotti SpA. These funds were not used to support this project.

Figures

Figure 1
Figure 1
Correlation between chest x-ray global score and (a) FiO2 at admission, (b) pO2 at admission in room air, and (c) pO2/FiO2 at admission in room air in the study population categorized in LIMC and HIMC groups. Black points indicate LIMC patients and purple points indicate HIMC patients.
Figure 2
Figure 2
Correlation between lung ultrasound (US) global score and FiO2 in the subgroup of patients undergoing US examination.
Figure 3
Figure 3
Correlation between lung US global score and X-ray global score in the overall study population.
Figure 4
Figure 4
Correlation between chest X-ray consolidation score and US global score in the overall study population.
See this image and copyright information in PMC

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