Can the Usage of the Chest X-Ray Scoring During Hospitalization in Patients with COVID-19 Predict the Severity of the Disease?

Objective: The prevalence of radiological involvement is considered a poor prognostic factor for coronavirus disease 2019 (COVID- 19). In our study, we aimed to investigate the threshold value of the chest X-ray (CXR) score, which would require the patient to be transferred to the intensive care unit (ICU) through scoring the CXR of COVID-19 patients receiving in-patient treatment.

Material and methods: The patients that tested positive for COVID-19 on the basis of the polymerase chain reaction (PCR) test, who was hospitalized in our hospital between the dates of March 15 and May 30, 2020, were included in the study. The CXRs of these patients taken during hospitalization were scored. The threshold value of the CXR score of the patients transferred to the ICU was calculated. Patients were grouped according to the threshold value of the CXR score, and demographic data and other recorded parameters were compared.

Results: A total of 301 patients were included in this retrospective cross-sectional study. It was determined that finding of a CXR score threshold value of 5 or above during hospitalization predicted a transfer to the ICU with 90% sensitivity and 80% specificity. The use of broad-spectrum antibiotics, the laboratory parameters (leukocyte, neutrophil, C-reactive protein (CRP), procalcitonin, troponin, D-dimer, ferritin), and rate of transfer to ICU were found to be significantly higher in the group with a CXR score of 5 and above, compared to the group with CXR score below 5 (P < .001 in each).

Conclusion: Finding high CXR scores during hospitalization due to COVID-19 may act as a warning in terms of the severity of the disease. It may be beneficial to examine the chest X-ray images during hospitalization with utmost care and take these images into account.