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Updated: Nov 8, 2025
Lung CT Segmentation to Identify Consolidations and Ground Glass Areas for Quantitative Assesment of SARS-CoV Pneumonia
Published on: December 19, 2020
Chest radiography predictor of COVID-19 adverse outcomes. A lesson learnt from the first wave
N Flor1, G Casazza2, L Saggiante3
1U.O. di Radiodiagnostica - Ospedale L. Sacco ASST Fatebenefratelli Sacco, Via Giovanni Battista Grassi, 74, 20157 Milano MI, Italy.
Insights
The Chest X-ray (CXR) Milan score effectively predicts adverse outcomes in COVID-19 patients. A higher score indicates a significantly increased risk of hospital admission and mortality.
Area of Science:
- Radiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) poses significant global health challenges.
- Predictive tools are crucial for managing patient outcomes and resource allocation.
Purpose of the Study:
- To evaluate the efficacy of a novel Chest X-ray (CXR) scoring system, the Milan score, in predicting adverse outcomes in COVID-19 patients.
- To determine if the Milan score can independently predict hospital admission and mortality.
Main Methods:
- A retrospective study included 554 laboratory-confirmed COVID-19 patients who underwent CXR.
- The Milan score quantified lung involvement (0-24) based on opacities and consolidation patterns.
- Statistical analysis, including univariate and multivariate models, assessed the score's predictive ability for hospital admission and mortality, adjusting for age, gender, and comorbidities.
Main Results:
- The in-hospital mortality rate was 16% among the 554 patients.
- The Milan score was an independent predictor of mortality and hospital admission in multivariate analysis.
- Patients with a Milan score ≥ 9 had a five-fold increased mortality risk compared to those with lower scores.
Conclusions:
- The CXR-based Milan score is a valuable and independent predictor of in-hospital mortality and hospital admission in COVID-19 patients.
- This scoring system can aid in risk stratification and clinical decision-making for COVID-19 management.
Aim:
To assess the role of a severity score based on chest radiography (CXR) in predicting the risk of adverse outcomes in coronavirus disease 2019 (COVID-19).
Materials And Methods:
Of the patients who presented to L. Sacco Hospital (Milan, Italy) between 21 February and 31 March 2020, patients with a laboratory confirmation of COVID-19 who also underwent a CXR were included in the study. To quantify the extent of lung involvement, each CXR image was given a score (Milan score), ranging from 0 to 24, depending on the presence of reticular pattern and/or ground-glass opacities and/or extensive consolidations in each of the 12 areas in which the lungs were divided. The score was calculated by an expert radiologist, blinded to laboratory tests. The ability of the Milan score to predict hospital admission and mortality, after adjusting for some variables (age; gender; comorbidities; time between symptoms onset and admission), using univariate and multivariate statistical analysis was investigated retrospectively.
Results:
Among the 554 patients, 115 of which (21%) had a negative CXR, the in-hospital mortality was 16% (90/554). At univariate analysis, age, gender, and comorbidities were significant predictors of mortality and hospital admission. At multivariate analysis, adjusting for age and gender, the Milan score was an independent predictor of mortality and hospitalisation. In particular, patients with a Milan score ≥ 9 had a mortality risk five-times higher than those with a lower score. Other independent predictors of mortality were gender and age.
Conclusions:
The CXR Milan score was an independent predictive factor of both in-hospital mortality and hospital admission.
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