Background: COVID-19 prognostic factors include age, sex, comorbidities, laboratory and imaging findings, and time from symptom onset to seeking care. Purpose: The study aim was to evaluate indices combining disease severity measures and time from disease onset to predict mortality of COVID-19 patients admitted to the emergency department (ED). Materials and methods: All consecutive COVID-19 patients who underwent both computed tomography (CT) and chest X-ray (CXR) at ED presentation between 27/02/2020 and 13/03/2020 were included. CT visual score of disease extension and CXR Radiographic Assessment of Lung Edema (RALE) score were collected. The CT- and CXR-based scores, C-reactive protein (CRP), and oxygen saturation levels (sO2) were separately combined with time from symptom onset to ED presentation to obtain severity/time indices. Multivariable regression age- and sex-adjusted models without and with severity/time indices were compared. For CXR-RALE, the models were tested in a validation cohort. Results: Of the 308 included patients, 55 (17.9%) died. In multivariable logistic age- and sex-adjusted models for death at 30 days, severity/time indices showed good discrimination ability, higher for imaging than for laboratory measures (AUCCT = 0.92, AUCCXR = 0.90, AUCCRP = 0.88, AUCsO2 = 0.88). AUCCXR was lower in the validation cohort (0.79). The models including severity/time indices performed slightly better than models including measures of disease severity not combined with time and those including the Charlson Comorbidity Index, except for CRP-based models. Conclusion: Time from symptom onset to ED admission is a strong prognostic factor and provides added value to the interpretation of imaging and laboratory findings at ED presentation.

Imaging-based indices combining disease severity and time from disease onset to predict COVID-19 mortality: A cohort study / Besutti, Giulia; Djuric, Olivera; Ottone, Marta; Monelli, Filippo; Lazzari, Patrizia; Ascari, Francesco; Ligabue, Guido; Guaraldi, Giovanni; Pezzuto, Giuseppe; Bechtold, Petra; Massari, Marco; Lattuada, Ivana; Luppi, Francesco; Galli, Maria Giulia; Pattacini, Pierpaolo; Giorgi Rossi, Paolo. - In: PLOS ONE. - ISSN 1932-6203. - 17:6(2022), pp. 1-14. [10.1371/journal.pone.0270111]

Imaging-based indices combining disease severity and time from disease onset to predict COVID-19 mortality: A cohort study

Besutti, Giulia;Monelli, Filippo;Lazzari, Patrizia;Ascari, Francesco;Ligabue, Guido;Guaraldi, Giovanni;
2022

Abstract

Background: COVID-19 prognostic factors include age, sex, comorbidities, laboratory and imaging findings, and time from symptom onset to seeking care. Purpose: The study aim was to evaluate indices combining disease severity measures and time from disease onset to predict mortality of COVID-19 patients admitted to the emergency department (ED). Materials and methods: All consecutive COVID-19 patients who underwent both computed tomography (CT) and chest X-ray (CXR) at ED presentation between 27/02/2020 and 13/03/2020 were included. CT visual score of disease extension and CXR Radiographic Assessment of Lung Edema (RALE) score were collected. The CT- and CXR-based scores, C-reactive protein (CRP), and oxygen saturation levels (sO2) were separately combined with time from symptom onset to ED presentation to obtain severity/time indices. Multivariable regression age- and sex-adjusted models without and with severity/time indices were compared. For CXR-RALE, the models were tested in a validation cohort. Results: Of the 308 included patients, 55 (17.9%) died. In multivariable logistic age- and sex-adjusted models for death at 30 days, severity/time indices showed good discrimination ability, higher for imaging than for laboratory measures (AUCCT = 0.92, AUCCXR = 0.90, AUCCRP = 0.88, AUCsO2 = 0.88). AUCCXR was lower in the validation cohort (0.79). The models including severity/time indices performed slightly better than models including measures of disease severity not combined with time and those including the Charlson Comorbidity Index, except for CRP-based models. Conclusion: Time from symptom onset to ED admission is a strong prognostic factor and provides added value to the interpretation of imaging and laboratory findings at ED presentation.
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Imaging-based indices combining disease severity and time from disease onset to predict COVID-19 mortality: A cohort study / Besutti, Giulia; Djuric, Olivera; Ottone, Marta; Monelli, Filippo; Lazzari, Patrizia; Ascari, Francesco; Ligabue, Guido; Guaraldi, Giovanni; Pezzuto, Giuseppe; Bechtold, Petra; Massari, Marco; Lattuada, Ivana; Luppi, Francesco; Galli, Maria Giulia; Pattacini, Pierpaolo; Giorgi Rossi, Paolo. - In: PLOS ONE. - ISSN 1932-6203. - 17:6(2022), pp. 1-14. [10.1371/journal.pone.0270111]
Besutti, Giulia; Djuric, Olivera; Ottone, Marta; Monelli, Filippo; Lazzari, Patrizia; Ascari, Francesco; Ligabue, Guido; Guaraldi, Giovanni; Pezzuto, Giuseppe; Bechtold, Petra; Massari, Marco; Lattuada, Ivana; Luppi, Francesco; Galli, Maria Giulia; Pattacini, Pierpaolo; Giorgi Rossi, Paolo
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/1282015
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