Does radiographic evaluation pulmonary edema score predict intensive care admission in COVID-19 patients presenting to the emergency department? A retrospective single-center observational study

Year 2022, , 1682 - 1687, 25.10.2022

Hilal Sipahioğlu , Ali Yeşilte , Mine Altınkaya Çavuş , Ayşe Kırış , Ahmet Savranlar

https://doi.org/10.32322/jhsm.1180896

Abstract

Aim: COVID-19 disease can progress from pneumonia to acute respiratory distress syndrome (ARDS). Performing computed tomography on all patients is expensive and exposes them to high radiation. The simple and reproducible Radiographic Evaluation Pulmonary Edema (RALE) score, used in ARDS and acute pulmonary edema in the emergency department, can predict the severity of the disease in COVID-19 patients.
Material and Method: In our study, a total of 221 COVID-19 patients we followed up between July-November, 2021 were evaluated retrospectively. The patients were divided into two as Intensive care hospitalization and no intensive care hospitalization.
Results: Ninety-five (43%) patients were admitted to the intensive care unit. The mean age (p<.001), white blood cell count (WBC) (p=.001), neutrophil count (p<.001), RALE score, and the number of hospitalization days of the patients admitted to the intensive care unit were higher (p<.001). These findings were positively correlated with the RALE score (p<.001). Age (p<.001), RALE score (p=.022), WBC (p=.029), and neutrophil count (p=.004) were independent risk factors in the multivariate analysis of factors affecting intensive care admission. RALE score cut-off value in predicting intensive care unit admission was ≥10.5. In the analysis with an Area Under the Curve value of 0.716, the application of this threshold resulted in a sensitivity of 67.4% and a specificity of 69.8%.
Conclusion: In conclusion, performing chest computed tomography in all patients admitted to the emergency department with COVID-19 disease increases the cost and exposure to radiation. The simple and recalculated RALE score can be used to predict intensive care admission in COVID-19 pneumonia.

Keywords

COVID-19, RALE, intensive care unit, emergency department

References

• Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020; 470-3.
• Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
• Yang W, Sirajuddin A, Zhang X, et al. The role of imaging in 2019 novel coronavirus pneumonia (COVID-19). Eur Radiol 2020; 30: 4874-82.
• Zhou S, Wang Y, Zhu T, Xia L. CT features of coronavirus disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China. AJR Am J Roentgenol 2020; 214: 1287-94.
• Giovagnoni A. Facing the COVID-19 emergency: we can and we do. Radiol Med 2020; 125: 337-8.
• Neri E, Miele V, Coppola F, Grassi R. Use of CT and artificial intelligence in suspected or COVID-19 positive patients: statement of the Italian Society of Medical and Interventional Radiology. Radiol Med 2020; 125: 505-8.
• ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection. American College of Radiology. March 11, 2020.
• Cozzi D, Albanesi M, Cavigli E, et al. Chest X-ray in new coronavirus disease 2019 (COVID-19) infection: findings and correlation with clinical outcome. Radiol Med 2020; 125: 730-7.
• Warren MA, Zhao Z, Koyama T, et al. Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS. Thorax 2018; 73: 840-6.
• Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246: 697-722.
• Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical coronavirus disease 2019 (COVID-19) pneumonia: relationship to negative RT-PCR testing. Radiology 2020; 296: E41-E5.
• Huang P, Liu T, Huang L, et al. Use of Chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 2020; 295: 22-3.
• Fang Y, Zhang H, Xie J, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020; 296: E115-E7.
• Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology 2020; 296: E32-E40.
• Choi H, Qi X, Yoon SH, et al. Extension of coronavirus disease 2019 on chest CT and Implications for chest radiographic ınterpretation. Radiol Cardiothorac Imaging 2020; 2: e200107.
• Ciceri F, Castagna A, Rovere-Querini P, et al. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clin Immunol 2020; 217: 108509.
• Marques P, Fernandez-Presa L, Carretero A, et al. The radiographic assessment of lung edema score of lung edema severity correlates with inflammatory parameters in patients with coronavirus disease 2019-Potential new admission biomarkers to predict coronavirus disease 2019 worsening. Front Med 2022; 9: 871714.
• Bellani G, Rouby JJ, Constantin JM, Pesenti A. Looking closer at acute respiratory distress syndrome: the role of advanced imaging techniques. Curr Opin Crit Care 2017; 23: 30-7.
• Sensusiati AD, Amin M, Nasronudin N, et al. Age, neutrophil lymphocyte ratio, and radiographic assessment of the quantity of lung edema (RALE) score to predict in-hospital mortality in COVID-19 patients: a retrospective study. F1000Res 2020; 9: 1286.