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Article data
Borghesi (2020)
Chest X-ray severity index as a predictor of in-hospital mortality in coronavirus disease 2019: A study of 302 patients from Italy
https://doi.org/10.1016/j.ijid.2020.05.021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7207134/

Results
Findings
Radiological finding during hospitalization (1 unit increase in Brixia score vs. Not applicable)
COVID-19 (death)
Odds ratio: 1.327 (1.200-1.472) Adjusted model

Study characteristics

Italy

Retrospective cohort study

Medical records

302

Through a retrospective search on the digital hospital archives between March 4, 2020 and March 24, 2020, all CXR reports including the new scoring system (the Brixia score) were retrieved. We enrolled only hospitalized 302 Caucasian patients with COVID-19 (confirmed by real-time polymerase chain reaction) for whom the final outcome (recovery or death) was available.

Patients with incomplete information about the presence of underlying comorbidities and immunosuppressive therapies were excluded from the study. For each included patient, only the CXR report with the highest score was considered for analysis. Each frontal chest projection linked to these reports was independently reviewed by a thoracic radiologist (A.B.), with 15 years’ experience of thoracic imaging, who reassigned the Brixia score. All chest X-rays were performed using portable digital radiography systems. Patient age, years 67.0 (57.0–77.0) Male 194 (64.2%)

Total

3 Week


Results

COVID-19 (death)

65

death due to COVID-19

Findings

Radiological finding during hospitalization

To improve the risk stratification for infected patients, we have introduced in clinical practice a new chest X-ray (CXR) scoring system for quantifying and monitoring the severity of lung abnormalities in patients with COVID-19 (Borghesi and Maroldi, 2020). This CXR scoring system (named the Brixia score) grades lung abnormalities due to COVID-19 on an 18-point severity scale.

Not applicable

1 unit increase in Brixia score

Odds ratio

1.327 (1.200-1.472)

No

Yes

Yes

Risk was adjusted for CXR- Brixia score, age and immunosuppressive therapies


Other information

Brixia score is a new chest X-ray scoring system designed for COVID-19 pneumonia. This study demonstrated for the first time that a high Brixia score and at least one other predictive factor — patient age and conditions that induced immunosuppression — conferred the highest risk of death due to COVID-19.

Average

Yes

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