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Published on: December 19, 2020
Development and validation of COVID-19 Radiological Risk Score (COVID-RRS): a multivariable radiological score to
W Schmidt1, K Pawlak-Buś, B Jóźwiak
1Rheumatology and Osteoporosis Ward, J. Strus Municipal Hospital in Poznan, Poznan, Poland. wiktorpawelschmidt@gmail.com.
Insights
A new COVID-19 Radiological Risk Score (COVID-RRS) predicts in-hospital mortality using chest CT findings. This score, incorporating lung involvement, pleural effusion, and consolidation, outperforms other methods.
Area of Science:
- Radiology
- Pulmonology
- Infectious Diseases
Background:
- Chest computed tomography (CT) is crucial for diagnosing Coronavirus Disease 2019 (COVID-19).
- Identifying accurate predictors of in-hospital mortality in COVID-19 patients is essential for clinical management.
Purpose of the Study:
- To develop and validate a novel risk score for predicting in-hospital mortality in COVID-19 patients.
- To assess the predictive performance of radiological findings on admission chest CT scans.
Main Methods:
- A single-center, longitudinal cohort study involving adult COVID-19 patients with positive RT-PCR and ground-glass opacities on chest CT.
- Development and validation of the COVID-19 Radiological Risk Score (COVID-RRS) using multivariate logistic regression analysis.
- Comparison of COVID-RRS predictive accuracy against existing scores like CTSS and TSS.
Main Results:
- The COVID-19 Radiological Risk Score (COVID-RRS) was developed, incorporating estimated lung involvement, pleural effusion, and consolidation-type changes.
- COVID-RRS demonstrated superior predictive performance for in-hospital mortality compared to lung involvement percentage alone, CTSS, and TSS (AUC 0.910 and 0.902).
- Twelve predictive factors (nine risk, three protective) were identified through univariate analysis.
Conclusions:
- Radiological aberrances on admission chest CT, beyond mere lung involvement extent, are significant independent predictors of COVID-19 mortality.
- The COVID-RRS is a simple, reliable, and clinically applicable tool for assessing in-hospital mortality risk in COVID-19 patients.
- The developed score offers improved prediction accuracy, aiding in clinical decision-making and patient stratification.
Objective:
To develop and validate in-hospital mortality risk score comprising radiological aberrances in chest computed tomography (CT) performed on admission.
Patients And Methods:
Single-center, longitudinal cohort study in adult patients admitted with Coronavirus Disease 2019 (COVID-19) to our ward. Patients were followed-up during hospitalization until discharge or death. Eligibility criteria for the study comprised positive real-time reverse transcription-polymerase chain reaction test (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and ground-glass opacities in chest CT. In-hospital death was the outcome of interest. Radiological, laboratory, and clinical data were analyzed. Radiological determinants of mortality were used as variables in multivariate logistic regression analysis, and results were used to build a radiological risk score.
Results:
371 patients were enrolled in development and validation cohorts (181 and 190 respectively), with a total of 47 non-survivors. Univariate analysis data determined 12 predictive factors (nine risk and three protective). In multivariate analysis, we developed COVID-RRS (COVID-19 Radiological Risk Score) - a radiological score predicting in-hospital COVID-19 mortality risk comprising estimated lung involvement percentage, pleural effusion, and domination of consolidation-type changes in chest CT. Our score was superior in the prediction of COVID-19 mortality to the percentage of lung involvement alone, Chest Computed Tomography Severity Score (CTSS), and Total Severity Score (TSS) in both groups with AUC of 0.910 and 0.902, respectively (p <0.001).
Conclusions:
Additional imaging features independently contribute to COVID-19 mortality risk. Our model comprising lung involvement estimation, pleural effusion, and domination of consolidations performed significantly better than scores based on the extent of the changes alone. COVID-RRS is a simple, reliable, and ready-to-use tool for clinical practice.
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