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Published on: December 19, 2020
Predicting the risk of chest radiograph abnormality 12-weeks post hospitalisation with SARS CoV-2 PCR confirmed
Tim Jm Wallis1, Benjamin Welham2, Alex Kong2
1Department of Respiratory Medicine and Southampton NIHR Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton, University of Southampton, Southampton, UK. timothy.wallis@soton.ac.uk.
Insights
A new SHADE-750 score accurately predicts persistent chest X-ray abnormalities in COVID-19 survivors. This tool helps identify patients who may not need routine radiological follow-up, reducing healthcare burdens.
Area of Science:
- Pulmonary Medicine
- Radiology
- Infectious Diseases
Background:
- Routine follow-up for COVID-19 survivors is resource-intensive.
- Previous work identified a 5-point score for predicting persistent chest X-ray (CXR) abnormalities.
- This study aimed to validate and refine this predictive score in an independent cohort.
Discussion:
- The SHADE-750 score, incorporating smoking history, higher-level care, age ≥50, admission duration ≥15 days, and LDH ≥750U/L, demonstrates strong predictive accuracy.
- The score showed robust performance across two independent cohorts and when combined.
- A score of zero indicated complete CXR resolution at 12 weeks, suggesting its utility in de-escalating follow-up.
Key Insights:
- Persistent CXR abnormalities were linked to older age, longer hospital stays, higher-level care, and smoking history.
- The refined SHADE-750 score achieved an AUROC of 0.75 in a combined cohort.
- The SHADE-750 score effectively identifies COVID-19 patients at low risk for persistent radiographic abnormalities.
Outlook:
- The SHADE-750 score can guide clinical decisions regarding the necessity of radiological follow-up for COVID-19 survivors.
- This tool has the potential to optimize healthcare resource allocation by identifying patients unlikely to benefit from routine monitoring.
- Further validation in diverse populations could enhance the generalizability of the SHADE-750 score.
Background:
Routine follow-up of patients hospitalised with COVID-19 is recommended, however due to the ongoing high number of infections this is not without significant health resource and economic burden. In a previous study we investigated the prevalence of, and risk factors for, persistent chest radiograph (CXR) abnormalities post-hospitalisation with COVID-19 and identified a 5-point composite score that strongly predicted risk of persistent CXR abnormality at 12-weeks. Here we sought to validate and refine our findings in an independent cohort of patients.
Methodology:
A single-centre prospective study of consecutive patients attending a virtual post-hospitalisation COVID-19 clinic and CXR as part of their standard clinical care between 2nd March - 22nd June 2021. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates (0-4 in each lung) with complete resolution defined as a follow-up score of zero.
Results:
182 consecutive patients were identified of which 31% had persistent CXR abnormality at 12-weeks. Patients with persistent CXR abnormality were significantly older (p < 0.001), had a longer hospital length of stay (p = 0.005), and had a higher incidence of both level 2 or 3 facility admission (level 2/3 care) (p = 0.003) and ever-smoking history (p = 0.038). Testing our composite score in the present cohort we found it predicted persistent CXR abnormality with reasonable accuracy (area under the receiver operator curve [AUROC 0.64]). Refining this score replacing obesity with Age ≥ 50 years, we identify the SHADE-750 score (1-point each for; Smoking history, Higher-level care (level 2/3 admission), Age ≥ 50 years, Duration of admission ≥ 15 days and Enzyme-lactate dehydrogenase (LDH ≥ 750U/L), that accurately predicted risk of persistent CXR abnormality, both in the present cohort (AUROC 0.73) and when retrospectively applied to our 1st cohort (AUROC 0.79). Applied to both cohorts combined (n = 213) it again performed strongly (AUROC 0.75) with all patients with a score of zero (n = 18) having complete CXR resolution at 12-weeks.
Conclusions:
In two independent cohorts of patients hospitalised with COVID-19, we identify a 5-point score which accurately predicts patients at risk of persistent CXR abnormality at 12-weeks. This tool could be used by clinicians to identify patients in which radiological follow-up may not be required.
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