Prognostic Value of the Brixia Radiological Score in COVID-19 Patients: A Retrospective Study from Romania

Abstract

The novel coronavirus pandemic, SARS-CoV-2, has a variable clinical spectrum, ranging from asymptomatic to critical forms. High mortality and morbidity rates have been associated with risk factors such as comorbidities, age, sex, and virulence factors specific to viral variants. Material and Methods: We retrospectively evaluated imaging characteristics using the Brixia radiological score in relation to favorable or unfavorable outcomes in adult patients. We included COVID-19 cases, admitted between 2020 and 2022, in a specialized pulmonology hospital with no intensive care unit. We analyzed 380 virologically confirmed COVID-19 cases, with a mean age of 52.8 ± 13.02 years. The mean Brixia radiological score at admission was 5.13 ± 3.56, reflecting predominantly mild-to-moderate pulmonary involvement. Multivariate analysis highlighted the utility of this score as a predictive marker for COVID-19 prognosis, with values >5 correlating with other severity biomarkers, NEWS-2 scores, and a lack of vaccination and hospitalization delay of more than 6 days from symptom onset. Summarizing, the Brixia score is itself an effective tool for screening COVID-19 cases at risk of death for early recognition of clinical deterioration and for decisions regarding appropriate care settings. Promoting vaccination can reduce the severity of radiological lesions, thereby decreasing the risk of death. Technologies based on artificial intelligence could optimize diagnosis and management decisions.

Keywords: Brixia score; COVID-19; emerging infectious disease; predictor death.

Figure 1

Brixia scoring by the sum of assigned scores from 0 to 3 for each of the 6 regions of the lungs. (A, B, C, D, E, F). Example of a global Brixia score of 15.

Figure 2

Forest plot illustrating the odds ratios and 95% confidence intervals from multivariate logistic regression to identify the relationship between a Brixia score over 5 and other predictors of unfavorable COVID-19 outcomes: unvaccinated, late presentation after 6 days from the onset, necessity of oxygen supply, increased CRP (>10 ng/dL), LDH > 450 U/L, and NLR over 4; level of significance p < 0.01, two-tailed.

Figure 3

AUC for various cut-off Brixia scores in differentiating between favorable outcomes due to COVID-19 and unfavorable outcomes.