Does the initial chest radiograph severity in COVID-19 impact the short- and long-term outcome? – a perspective from India

Abstract

Purpose

The chest radiograph (CXR) is among the most widely used investigations in coronavirus disease 2019 (COVID-19) patients. Little is known about its predictive role on the long-term outcome. The purpose of this study was to explore its association with the short and long-term outcome in COVID-19 patients.

Methods

A total of 1530 patients were assessed for the presence, radiographic pattern and distribution of lung lesions observed on baseline chest radiographs obtained at admission. The Brixia scoring system was applied for semiquantitative assessment of lesion severity. Short-term outcome was determined by clinical severity, duration of hospitalization and mortality. The 1415 survivors in this group were assessed after 5–6 months for the presence of residual symptoms.

Results

About 67% patients had an abnormal baseline CXR. Bilateral involvement with a basal preponderance was observed and ground-glass opacification was the most frequent finding. The Brixia score ranged from 0 to 16, median 2, interquartile range (IQR) [0–6]. About 36% patients were symptomatic on 5–6-month follow-up, with fatigability being the commonest symptom. A good correlation was observed between the CXR score and disease severity as well as duration of hospitalization. On multivariate analysis, the CXR score was found to be a significant independent predictor of in-patient mortality as well as presence of long-term residual symptoms in survivors.

Conclusions

Disease severity as seen on the chest radiograph appears to play an important role in driving the short and long-term consequences of COVID-19 and could serve as a prognostic indicator, which influences short-term management and long-term follow-up.

Keywords:

• COVID-19
• chest radiograph
• long-term outcome
• short-term outcome

Acknowledgements

The authors gratefully acknowledge the valuable contributions of Maj Gen Aftab Alam, AC-IDS (Med) towards preparation of this manuscript. They also gratefully acknowledge the contributions of Dr. Abhinav Jaimini, Dr. Lokesh Kumar, Pawan Kumar, Santosh Pandey, Sanjiv Saw, Yachna Solanki and Prabhjot Kaur towards data collection.

Disclosure statement

The authors whose names are listed above certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. There are no conflicts of interest.

Submission declaration

The work described has not been published previously in any form, it is not under consideration for publication elsewhere, its publication is approved by all authors and if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright holder.