Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 26;12(9):2072.
doi: 10.3390/diagnostics12092072.

The RALE Score Versus the CT Severity Score in Invasively Ventilated COVID-19 Patients-A Retrospective Study Comparing Their Prognostic Capacities

Christel M Valk  1 , Claudio Zimatore  1   2 , Guido Mazzinari  3   4 , Charalampos Pierrakos  1   5 , Chaisith Sivakorn  6 , Jutamas Dechsanga  7 , Salvatore Grasso  2 , Ludo Beenen  8 , Lieuwe D J Bos  1   9 , Frederique Paulus  1 , Marcus J Schultz  1   10   11 , Luigi Pisani  1   10   12
Affiliations

The RALE Score Versus the CT Severity Score in Invasively Ventilated COVID-19 Patients-A Retrospective Study Comparing Their Prognostic Capacities

Christel M Valk et al. Diagnostics (Basel). .

Abstract

Background: Quantitative radiological scores for the extent and severity of pulmonary infiltrates based on chest radiography (CXR) and computed tomography (CT) scan are increasingly used in critically ill invasively ventilated patients. This study aimed to determine and compare the prognostic capacity of the Radiographic Assessment of Lung Edema (RALE) score and the chest CT Severity Score (CTSS) in a cohort of invasively ventilated patients with acute respiratory distress syndrome (ARDS) due to COVID-19.

Methods: Two-center retrospective observational study, including consecutive invasively ventilated COVID-19 patients. Trained scorers calculated the RALE score of first available CXR and the CTSS of the first available CT scan. The primary outcome was ICU mortality; secondary outcomes were duration of ventilation in survivors, length of stay in ICU, and hospital-, 28-, and 90-day mortality. Prognostic accuracy for ICU death was expressed using odds ratios and Area Under the Receiver Operating Characteristic curves (AUROC).

Results: A total of 82 patients were enrolled. The median RALE score (22 [15-37] vs. 26 [20-39]; p = 0.34) and the median CTSS (18 [16-21] vs. 21 [18-23]; p = 0.022) were both lower in ICU survivors compared to ICU non-survivors, although only the difference in CTSS reached statistical significance. While no association was observed between ICU mortality and RALE score (OR 1.35 [95%CI 0.64-2.84]; p = 0.417; AUC 0.50 [0.44-0.56], this was noticed with the CTSS (OR, 2.31 [1.22-4.38]; p = 0.010) although with poor prognostic capacity (AUC 0.64 [0.57-0.69]). The correlation between the RALE score and CTSS was weak (r2 = 0.075; p = 0.012).

Conclusions: Despite poor prognostic capacity, only CTSS was associated with ICU mortality in our cohort of COVID-19 patients.

Keywords: ARDS; CT severity score; CTSS; ICU; RALE score; chest X-ray; chest computed tomography; chest imaging; coronavirus disease 2019; mechanical ventilation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient flow. Consecutive patients were screened for participation. Patients were selected if having received invasive ventilation for acute hypoxemic respiratory failure due to COVID-19 that was confirmed by reverse transcriptase–polymerase chain reaction for SARS-CoV-2. Abbreviations: CXR: chest X-ray; CT: chest CT scan.
Figure 2
Figure 2
Boxplots of the (A) RALE score and (B) CTSS in survivors versus non-survivors.
Figure 3
Figure 3
Scatterplot showing the correlation between the RALE score and the CTSS, with the linear regression estimation (in blue), and the 95%CI shown in shaded area. R2 = 0.075; p = 0.012. Beta coefficient for RALE score: 0.08 [95%CI 0.02–0.16].
Figure 4
Figure 4
Discriminative capacity of (A) the RALE score and (B) the CTSS for ICU mortality. Shaded areas show 95% confidence intervals. Abbreviations: AUC: area under the curve; RALE: Radiographic Assessment of Lung Edema; CTSS: Chest CT Severity Score.
See this image and copyright information in PMC

References

    1. Valk C.M.A., Zimatore C., Mazzinari G., Pierrakos C., Sivakorn C., Dechsanga J., Grasso S., Beenen L., Bos L.D.J., Paulus F., et al. The Prognostic Capacity of the Radiographic Assessment for Lung Edema Score in Patients With COVID-19 Acute Respiratory Distress Syndrome—An International Multicenter Observational Study. Front. Med. 2022;8 doi: 10.3389/fmed.2021.772056. - DOI - PMC - PubMed
    1. Treanor L., Islam N., Ebrahimzadeh S., McInnes M.D.F. Role of Imaging in Diagnosing COVID-19. Radiology. 2021;299:E289. doi: 10.1148/radiol.2021210564. - DOI - PMC - PubMed
    1. Schalekamp S., Bleeker-Rovers C.P., Beenen L.F.M., Quarles van Ufford H.M.E., Gietema H.A., Stöger J.L., Harris V., Reijers M.H.E., Rahamat-Langendoen J., Korevaar D.A., et al. Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience. Radiology. 2021;298:E98–E106. doi: 10.1148/radiol.2020203465. - DOI - PMC - PubMed
    1. Warren M.A., Zhao Z., Koyama T., Bastarache J.A., Shaver C.M., Semler M.W., Rice T.W., Matthay M.A., Calfee C.S., Ware L.B. Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS. Thorax. 2018;73:840–846. doi: 10.1136/thoraxjnl-2017-211280. - DOI - PMC - PubMed
    1. Ebrahimian S., Homayounieh F., Rockenbach M., Putha P., Raj T., Dayan I., Bizzo B.C., Buch V., Wu D., Kim K., et al. Artificial intelligence matches subjective severity assessment of pneumonia for prediction of patient outcome and need for mechanical ventilation: A cohort study. Sci. Rep. 2021;11:858. doi: 10.1038/s41598-020-79470-0. - DOI - PMC - PubMed

LinkOut - more resources