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Tenda ED, Yunus RE, Zulkarnaen B, Yugo MR, Pitoyo CW, Asaf MM, Islamiyati TN, Pujitresnani A, Setiadharma A, Henrina J, Rumende CM, Wulani V, Harimurti K, Lydia A, Shatri H, Soewondo P, Yusuf PA. Comparison of the Discrimination Performance of AI Scoring and the Brixia Score in Predicting COVID-19 Severity on Chest X-Ray Imaging: Diagnostic Accuracy Study. JMIR Form Res 2024; 8:e46817. [PMID: 38451633 PMCID: PMC10958333 DOI: 10.2196/46817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/28/2023] [Accepted: 12/29/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The artificial intelligence (AI) analysis of chest x-rays can increase the precision of binary COVID-19 diagnosis. However, it is unknown if AI-based chest x-rays can predict who will develop severe COVID-19, especially in low- and middle-income countries. OBJECTIVE The study aims to compare the performance of human radiologist Brixia scores versus 2 AI scoring systems in predicting the severity of COVID-19 pneumonia. METHODS We performed a cross-sectional study of 300 patients suspected with and with confirmed COVID-19 infection in Jakarta, Indonesia. A total of 2 AI scores were generated using CAD4COVID x-ray software. RESULTS The AI probability score had slightly lower discrimination (area under the curve [AUC] 0.787, 95% CI 0.722-0.852). The AI score for the affected lung area (AUC 0.857, 95% CI 0.809-0.905) was almost as good as the human Brixia score (AUC 0.863, 95% CI 0.818-0.908). CONCLUSIONS The AI score for the affected lung area and the human radiologist Brixia score had similar and good discrimination performance in predicting COVID-19 severity. Our study demonstrated that using AI-based diagnostic tools is possible, even in low-resource settings. However, before it is widely adopted in daily practice, more studies with a larger scale and that are prospective in nature are needed to confirm our findings.
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Affiliation(s)
- Eric Daniel Tenda
- Department of Internal Medicine, Pulmonology and Critical Care Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Reyhan Eddy Yunus
- Department of Radiology, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Benny Zulkarnaen
- Department of Radiology, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Reynalzi Yugo
- Department of Radiology, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Ceva Wicaksono Pitoyo
- Department of Internal Medicine, Pulmonology and Critical Care Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Moses Mazmur Asaf
- Department of Radiology, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Tiara Nur Islamiyati
- Department of Internal Medicine, Pulmonology and Critical Care Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Arierta Pujitresnani
- Department of Medical Physiology and Biophysics/ Medical Technology Cluster IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Andry Setiadharma
- Department of Internal Medicine, Pulmonology and Critical Care Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Joshua Henrina
- Department of Internal Medicine, Pulmonology and Critical Care Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Cleopas Martin Rumende
- Department of Internal Medicine, Pulmonology and Critical Care Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Vally Wulani
- Department of Radiology, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Department of Internal Medicine, Geriatric Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Aida Lydia
- Department of Internal Medicine, Nephrology and Hypertension Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Hamzah Shatri
- Department of Internal Medicine, Psychosomatic Division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Pradana Soewondo
- Department of Internal Medicine, Endocrinology - Metabolism - Diabetes division, Faculty of Medicine Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia
| | - Prasandhya Astagiri Yusuf
- Department of Medical Physiology and Biophysics/ Medical Technology Cluster IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Ayoub SE, Shaker OG, Masoud M, Hassan EA, Ezzat EM, Ahmed MI, Ahmed RI, Amin AAI, Abd El Reheem F, Khalefa AA, Mahmoud RH. Altered expression of serum lncRNA CASC2 and miRNA-21-5p in COVID-19 patients. Hum Genomics 2024; 18:18. [PMID: 38342902 PMCID: PMC10860220 DOI: 10.1186/s40246-024-00578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/24/2024] [Indexed: 02/13/2024] Open
Abstract
Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has a high incidence of spread. On January 30, 2020, the World Health Organization proclaimed a public health emergency of worldwide concern. More than 6.9 million deaths and more than 768 million confirmed cases had been reported worldwide as of June 18, 2023. This study included 51 patients and 50 age- and sex-matched healthy subjects. The present study aimed to identify the expression levels of lncRNA CASC2 and miRNA-21-5p (also known as miRNA-21) in COVID-19 patients and their relation to the clinicopathological characteristics of the disease. The expression levels of noncoding RNAs were measured by RT-PCR technique. Results detected that CASC2 was significantly downregulated while miRNA-21-5p was significantly upregulated in COVID-19 patients compared to healthy subjects. A significant negative correlation was found between CASC2 and miRNA-21-5p. ROC curve analysis used to distinguish COVID-19 patients from controls. MiRNA-21-p serum expression level had a significant positive association with temperature and PO2 (p = 0.04 for each). These findings indicate that CASC2 and miRNA-21-p might be used as potential diagnostic and therapeutic biomarkers in COVID-19.
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Affiliation(s)
- Shymaa E Ayoub
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University, Fayoum, 63514, Egypt.
| | - Olfat G Shaker
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Masoud
- Department of Public Health and Community Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Essam A Hassan
- Department of Tropical Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Eman M Ezzat
- Department of Internal Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mona I Ahmed
- Department of Chest Disease and Tuberculosis, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Randa I Ahmed
- Department of Chest Disease and Tuberculosis, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Amal A Ibrahim Amin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Fadwa Abd El Reheem
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Abeer A Khalefa
- Department of Physiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rania H Mahmoud
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University, Fayoum, 63514, Egypt
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Baig MMA, Adnan M, Baig MU, Ramzan Z. Late-onset pulmonary complications among survivors of coronavirus Disease 2019. Pak J Med Sci 2023; 39:1035-1039. [PMID: 37492317 PMCID: PMC10364300 DOI: 10.12669/pjms.39.4.6302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 07/27/2023] Open
Abstract
Objectives To assess the late-onset pulmonary complications among survivors of coronavirus disease 2019. Methods The cross-sectional analytical study was conducted in the department of Pulmonology, Sir Ganga Ram Hospital Lahore between October 2020 and March 2021. Total 288 patients visiting the hospital 12-week after recovery from COVID-19 enrolled using convenience sampling. After excluding patients (n=61) with a history of previous respiratory symptoms before the development of COVID-19, data from 227 patients was subjected to final analysis. Chest X-ray (CXR) was used to evaluate lung condition. Results Participation of middle-aged adults (54.6%) was higher than older (38.3%) and young adults (7.0%). The percentage of males was 55.5% and smokers was 29.1%. Dyspnea was the most common complication as 80.0% patients had moderate to severe dyspnea while chronic cough was 78.0% and lung fibrosis (LF) was 13.2%. The chances of LF increased with the rise in age (p-value 0.033). However, the distribution of LF was similar between males and females. The frequency of lung fibrosis in smokers was 3-time higher than among non-smokers (24.2 vs. 8.7%; p-value 0.003). The patients with LF were more dependent on O2 as compared to the patients without LF (p-value < 0.001). The frequency of tachycardia was significantly different between patients with and without LF (all p-values < 0.05). Conclusion LF is a common late-onset pulmonary complication of COVID-19 and is associated with old age, smoking, O2 dependency, tachycardia, and severe dyspnea.
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Affiliation(s)
| | - Muhammad Adnan
- Muhammad Adnan, Health Research Institute, National Institute of Health, HRI NIH Research Center FJMU, Lahore, Pakistan
| | | | - Zohaib Ramzan
- Zohaib Ramzan Department of Pulmonology, Sir Ganga Ram Hospital, Lahore, Pakistan
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Nukovic JA, Opancina V, Zdravkovic N, Prodanovic N, Pejcic A, Opancina M, Nukovic JJ, Vojinovic R, Dulovic D, Jukovic F, Hamzagic N, Nukovic M, Markovic NV. Brixia Chest X-ray Score, Laboratory Parameters and Vaccination Status for Prediction of Mortality in COVID-19 Hospitalized Patients. Diagnostics (Basel) 2023; 13:2122. [PMID: 37371019 DOI: 10.3390/diagnostics13122122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Chest X-ray has verified its role as a crucial tool in COVID-19 assessment due to its practicability, especially in emergency units, and Brixia score has proven as a useful tool for COVID-19 pneumonia grading. The aim of our study was to investigate correlations between main laboratory parameters, vaccination status, and Brixia score, as well as to confirm if Brixia score is a significant independent predictor of unfavorable outcome (death) in COVID-19 patients. The study was designed as a cross-sectional multicentric study. It included patients with a diagnosed COVID-19 infection who were hospitalized. This study included a total of 279 patients with a median age of 62 years. The only significant predictor of unfavorable outcome (death) was Brixia score (adjusted odds ratio 1.148, p = 0.022). In addition, the results of the multiple linear regression analysis (R2 = 0.334, F = 19.424, p < 0.001) have shown that male gender (B = 0.903, p = 0.046), severe COVID-19 (B = 1.970, p < 0.001), and lactate dehydrogenase (B = 0.002, p < 0.001) were significant positive predictors, while albumin level (B = -0.211, p < 0.001) was a significant negative predictor of Brixia score. Our results provide important information about factors influencing Brixia score and its usefulness in predicting the unfavorable outcome (death) of COVID-19 patients. These findings have clinical relevance, especially in epidemic circumstances.
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Affiliation(s)
- Jusuf A Nukovic
- Faculty of Pharmacy and Health Travnik, University of Travnik, 72270 Travnik, Bosnia and Herzegovina
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Valentina Opancina
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Nebojsa Zdravkovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Nikola Prodanovic
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ana Pejcic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Miljan Opancina
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Military Medical Academy, Faculty of Medicine, University of Defense, 11000 Belgrade, Serbia
| | - Jasmin J Nukovic
- Faculty of Pharmacy and Health Travnik, University of Travnik, 72270 Travnik, Bosnia and Herzegovina
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Radisa Vojinovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Dragan Dulovic
- Military Medical Academy, Faculty of Medicine, University of Defense, 11000 Belgrade, Serbia
| | - Fehim Jukovic
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | | | - Merisa Nukovic
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Nenad V Markovic
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Shrestha A, Shrestha S, Tuladhar AS, Kayastha R, Khanal R, Chaudhary A, Bhattarai A, Bimali S. Mean Brixia Severity Scores among Symptomatic COVID-19 Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2023; 61:455-459. [PMID: 37203888 PMCID: PMC10896441 DOI: 10.31729/jnma.8165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction COVID-19 is a highly contagious viral disease which escalated into a global pandemic since its outbreak on 31 December 2019. Chest X-rays are the most common investigation in suspected cases to diagnose and manage pneumonia. The aim of this study was to find out the mean Brixia severity scores among symptomatic COVID-19 patients in a tertiary care centre. Methods A descriptive cross-sectional study was conducted among the chest X-rays of symptomatic COVID-19-positive patients of a tertiary care centre. Data from 1 May 2021 to 31 July 2021 were collected between 1 August 2022 and 1 January 2023 from the hospital records. Ethical approval was taken from Institutional Review Committee (Reference number: 01-079/080). Patients with reverse transcriptase polymerase chain reaction with symptoms of COVID-19 were included in this study. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results Among the total of 300 patients, the mean Brixia severity score was 7.15±5.07 and out of 235 patients with abnormal chest X-ray, the mean Brixia severity score was 9.13±3.84. A total of 68 (22.66%) patients had mild, 115 (38.33%) had moderate and 52 (17.33%) had severe scores. Conclusions The mean Brixia severity score among symptomatic COVID-19 patients was found to be higher than the other studies done in similar settings. Keywords COVID-19; Nepal; pneumonia; prevalence; x-ray.
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Affiliation(s)
- Amit Shrestha
- Department of Radiology, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | - Subodh Shrestha
- Department of Radiology, Om Hospital and Research Centre, Chabahil, Kathmandu, Nepal
| | | | - Rumita Kayastha
- Department of Radiology, Madhyapur Thimi Hospital, Bhaktapur, Nepal
| | - Roja Khanal
- Department of Radiology, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | | | - Anish Bhattarai
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | - Sneha Bimali
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
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O'Reilly PA, Lewis S, Reed W. Assessing the implementation of COVID-19 structured reporting templates for chest radiography: a scoping review. BJR Open 2023; 5:20220058. [PMID: 37389002 PMCID: PMC10301714 DOI: 10.1259/bjro.20220058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Objective One of the common modalities used in imaging COVID-19 positive patients is chest radiography (CXR), and serves as a valuable imaging method to diagnose and monitor a patients' condition. Structured reporting templates are regularly used for the assessment of COVID-19 CXRs and are supported by international radiological societies. This review has investigated the use of structured templates for reporting COVID-19 CXRs. Methods A scoping review was conducted on literature published between 2020 and 2022 using Medline, Embase, Scopus, Web of Science, and manual searches. An essential criterion for the inclusion of the articles was the use of reporting methods employing either a structured quantitative or qualitative reporting method. Thematic analyses of both reporting designs were then undertaken to evaluate utility and implementation. Results Fifty articles were found with the quantitative reporting method used in 47 articles whilst 3 articles were found employing a qualitative design. Two quantitative reporting tools (Brixia and RALE) were used in 33 studies, with other studies using variations of these methods. Brixia and RALE both use a posteroanterior or supine CXR divided into sections, Brixia with six and RALE with four sections. Each section is scaled numerically depending on the level of infection. The qualitative templates relied on selecting the best descriptor of the presence of COVID-19 radiological appearances. Grey literature from 10 international professional radiology societies were also included in this review. The majority of the radiology societies recommend a qualitative template for reporting COVID-19 CXRs. Conclusion Most studies employed quantitative reporting methods which contrasted with the structured qualitative reporting template advocated by most radiological societies. The reasons for this are not entirely clear. There is also a lack of research literature on both the implementation of the templates or comparing both template types, indicating that the use of structured radiology reporting types may be an underdeveloped clinical strategy and research methodology. Advances in knowledge This scoping review is unique in that it has undertaken an examination of the utility of the quantitative and qualitative structured reporting templates for COVID-19 CXRs. Moreover, through this review, the material examined has allowed a comparison of both instruments, clearly showing the favoured style of structured reporting by clinicians. At the time of the database interrogation, there were no studies found had undertaken such examinations of both reporting instruments. Moreover, due to the enduring influence of COVID-19 on global health, this scoping review is timely in examining the most innovative structured reporting tools that could be used in the reporting of COVID-19 CXRs. This report could assist clinicians in decision-making regarding templated COVID-19 reports.
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Affiliation(s)
- Peter A O'Reilly
- Academic, Discipline of Medical Imaging Science, The University of Sydney School of Health Sciences, Camperdown, Sydney, Australia
| | - Sarah Lewis
- Associate Dean Research Performance, Faculty of Medicine and Health, The University of Sydney School of Health Sciences, Camperdown, Sydney, Australia
| | - Warren Reed
- Program Director, Bachelor of Applied Science (Diagnostic Radiography), The University of Sydney School of Health Sciences, Camperdown, Sydney, Australia
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Labuschagne HC, Venturas J, Moodley H. Risk stratification of hospital admissions for COVID-19 pneumonia by chest radiographic scoring in a Johannesburg tertiary hospital. S Afr Med J 2023; 113:75-83. [PMID: 36757072 DOI: 10.7196/samj.2023.v113i2.16681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Chest radiographic scoring systems for COVID-19 pneumonia have been developed. However, little is published on the utilityof these scoring systems in low- and middle-income countries. OBJECTIVES To perform risk stratification of COVID-19 pneumonia in Johannesburg, South Africa (SA), by comparing the Brixia score withclinical parameters, disease course and clinical outcomes. To assess inter-rater reliability and developing predictive models of the clinicaloutcome using the Brixia score and clinical parameters. METHODS Retrospective investigation was conducted of adult participants with established COVID-19 pneumonia admitted at a tertiaryinstitution from 1 May to 30 June 2020. Two radiologists, blinded to clinical data, assigned Brixia scores. Brixia scores were compared withclinical parameters, length of stay and clinical outcomes (discharge/death). Inter-rater agreement was determined. Multivariable logisticregression extracted variables predictive of in-hospital demise. RESULTS The cohort consisted of 263 patients, 51% male, with a median age of 47 years (interquartile range (IQR) = 20; 95% confidenceinterval (CI) 46.5 - 49.9). Hypertension (38.4%), diabetes (25.1%), obesity (19.4%) and HIV (15.6%) were the most common comorbidities.The median length of stay for 258 patients was 7.5 days (IQR = 7; 95% CI 8.2 - 9.7) and 6.5 days (IQR = 8; 95% CI 6.5 - 12.5) for intensivecare unit stay. Fifty (19%) patients died, with a median age of 55 years (IQR = 23; 95% CI 50.5 - 58.7) compared with survivors, of medianage 46 years (IQR = 20; 95% CI 45 - 48.6) (p=0.01). The presence of one or more comorbidities resulted in a higher death rate (23% v. 9.2%;p=0.01) than without comorbidities. The median Brixia score for the deceased was higher (14.5) than for the discharged patients (9.0)(p<0.001). Inter-rater agreement for Brixia scores was good (intraclass correlation coefficient 0.77; 95% CI 0.6 - 0.85; p<0.001). A modelcombining Brixia score, age, male gender and obesity (sensitivity 84%; specificity 63%) as well as a model with Brixia score and C-reactiveprotein (CRP) count (sensitivity 81%; specificity 63%) conferred the highest risk for in-hospital mortality. CONCLUSION We have demonstrated the utility of the Brixia scoring system in a middle-income country setting and developed the first SArisk stratification models incorporating comorbidities and a serological marker. When used in conjunction with age, male gender, obesityand CRP, the Brixia scoring system is a promising and reliable risk stratification tool. This may help inform the clinical decision pathway inresource-limited settings like ours during future waves of COVID-19.
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Affiliation(s)
- H C Labuschagne
- Department of Radiology, Charlotte Maxeke Johannesburg Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - J Venturas
- Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand.
| | - H Moodley
- Department of Radiology, Charlotte Maxeke Johannesburg Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Filip C, Covali R, Socolov D, Akad M, Carauleanu A, Vasilache IA, Scripcariu IS, Pavaleanu I, Butureanu T, Ciuhodaru M, Boiculese LV, Socolov R. Brixia and qSOFA Scores, Coagulation Factors and Blood Values in Spring versus Autumn 2021 Infection in Pregnant Critical COVID-19 Patients: A Preliminary Study. Healthcare (Basel) 2022; 10:1423. [PMID: 36011083 PMCID: PMC9408262 DOI: 10.3390/healthcare10081423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: From the recent variants of concern of the SARS-CoV-2 virus, in which the delta variant generated more negative outcomes than the alpha, we hypothesized that lung involvement, clinical condition deterioration and blood alterations were also more severe in autumn infection, when the delta variant dominated (compared with spring infections, when the alpha variant dominated), in severely infected pregnant patients. (2) Methods: In a prospective study, all pregnant patients admitted to the ICU of the Elena Doamna Obstetrics and Gynecology Hospital with a critical form of COVID-19 infection-spring group (n = 11) and autumn group (n = 7)-between 1 January 2021 and 1 December 2021 were included. Brixia scores were calculated for every patient: A score, upon admittance; H score, the highest score throughout hospitalization; and E score, at the end of hospitalization. For each day of Brixia A, H or E score, the qSOFA (quick sepsis-related organ failure assessment) score was calculated, and the blood values were also considered. (3) Results: Brixia E score, C-reactive protein, GGT and LDH were much higher, while neutrophil count was much lower in autumn compared with spring critical-form pregnant patients. (4) Conclusions: the autumn infection generated more dramatic alterations than the spring infection in pregnant patients with critical forms of COVID-19. Larger studies with more numerous participants are required to confirm these results.
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Affiliation(s)
- Catalina Filip
- Department of Vascular Surgery, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Roxana Covali
- Department of Radiology, Elena Doamna Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, Cuza Voda Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (D.S.); (A.C.); (I.A.V.); (I.S.S.)
| | - Mona Akad
- Department of Obstetrics and Gynecology, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Alexandru Carauleanu
- Department of Obstetrics and Gynecology, Cuza Voda Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (D.S.); (A.C.); (I.A.V.); (I.S.S.)
| | - Ingrid Andrada Vasilache
- Department of Obstetrics and Gynecology, Cuza Voda Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (D.S.); (A.C.); (I.A.V.); (I.S.S.)
| | - Ioana Sadiye Scripcariu
- Department of Obstetrics and Gynecology, Cuza Voda Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (D.S.); (A.C.); (I.A.V.); (I.S.S.)
| | - Ioana Pavaleanu
- Department of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (I.P.); (T.B.); (M.C.); (R.S.)
| | - Tudor Butureanu
- Department of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (I.P.); (T.B.); (M.C.); (R.S.)
| | - Madalina Ciuhodaru
- Department of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (I.P.); (T.B.); (M.C.); (R.S.)
| | - Lucian Vasile Boiculese
- Department of Statistics, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Razvan Socolov
- Department of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (I.P.); (T.B.); (M.C.); (R.S.)
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Deif MA, Mounir AM, Abo-Hedibah SA, Abdel Khalek AM, Elmokadem AH. Outcome of percutaneous drainage for septic complications coexisted with COVID-19. World J Radiol 2022; 14:91-103. [PMID: 35646292 PMCID: PMC9124979 DOI: 10.4329/wjr.v14.i4.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/13/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019 (COVID-19) combined with viral load, and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration.
AIM To describe the clinical, radiological, and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their post-procedural outcomes.
METHODS This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications. The mean age ± SD of the patients was 48.5 ± 14 years (range 30-72 years). Three patients underwent cholecystostomy for acute acalculous cholecystitis. Percutaneous drainage was performed in seven patients; two peripancreatic collections; two infected leaks after hepatic resection; one recurrent hepatic abscess, one psoas abscess and one lumbar abscess. One patient underwent a percutaneous nephrostomy for acute pyelonephritis.
RESULTS Technical success was achieved in 100% of patients, while clinical success was achieved in 4 out of 11 patients (36.3%). Six patients (54.5%) died despite proper percutaneous drainage and adequate antibiotic coverage. One patient (9%) needed operative intervention. Two patients (18.2%) had two drainage procedures to drain multiple fluid collections. Two patients (18.2%) had repeat drainage procedures due to recurrent fluid collections. The average volume of the drained fluid immediately after tube insertion was 85 mL. Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients. There was no significant statistical difference (P = 0.6 and 0.4) between the mean of WBCs and neutrophils count before drainage and seven days after drainage. The lymphocyte count shows significant increased seven days after drainage (P = 0.03).
CONCLUSION In this study, patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.
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Affiliation(s)
- Mohamed A Deif
- Department of Radiology, National Liver Institute, Menoufia University, Shibin Al Kawm 32521, Egypt
| | - Ahmad M Mounir
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
| | | | | | - Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
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10
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Elmokadem AH, Bayoumi D, Mansour M, Ghonim M, Saad EA, Khedr D. COVID-19-associated acute invasive fungal sinusitis: Clinical and imaging findings. J Neuroimaging 2022; 32:676-689. [PMID: 35043509 DOI: 10.1111/jon.12967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose is to provide a comprehensive report describing the clinical and imaging features of Coronavirus disease 2019 (COVID-19)-related acute invasive fungal sinusitis (AIFS) and associated comorbidities. METHODS A retrospective study was conducted on 25 patients (12 males and 13 females, mean age of 53.9±9.1 years). All patients had positive polymerase chain reaction test for COVID-19 and histopathological proof of AIFS. Patients underwent computed tomography (CT) and magnetic resonance examinations to assess sinonasal, orbital, and cranial spread. RESULTS The most prevalent comorbidity among the study cohort was diabetes mellitus (DM). Twenty-one patients (84%) were diagnosed in the post-COVID-19 period after hospital discharge, with a mean interval of 19.1±9.2 days. Steroid treatment was given to 19 patients (76%). Orbital manifestations were the presenting symptoms in all patients, followed by facial edema, nasal discharge, and neurological symptoms. Sinonasal involvement ranged from mucosal thickening to complete sinus opacification by a predominant isodensity on CT, low T1, and high T2 signal intensity with variable enhancement patterns. Twenty-four patients had a unilateral orbital extension, and 12 patients showed signs of intracranial extension. Bone involvement was detected in 16 patients (64%). Follow-up scans in 18 patients (72%) showed rapid progression of the disease. Eight patients (32%) died, six from neurological complications and two from severe respiratory failure. CONCLUSION Steroids, DM, and severe COVID-19 are the major risk factors of AIFS in the post-COVID-19 era. Imaging scans in all patients revealed different sinonasal, facial, orbital features, and intracranial involvement with rapid progression of the findings on follow-up scans.
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Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura, Egypt.,Department of Radiology, Farwaniya Hospital, Sabah Al Nasser, Kuwait
| | - Dalia Bayoumi
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Manar Mansour
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Mahitab Ghonim
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Eman A Saad
- Department of Pathology, Mansoura University, Mansoura, Egypt
| | - Doaa Khedr
- Department of Radiology, Mansoura University, Mansoura, Egypt
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Elmokadem AH, Mounir AM, Ramadan ZA, Elsedeiq M, Saleh GA. Comparison of chest CT severity scoring systems for COVID-19. Eur Radiol 2022; 32:3501-3512. [PMID: 35031841 PMCID: PMC8760133 DOI: 10.1007/s00330-021-08432-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/27/2021] [Accepted: 10/23/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the diagnostic performance and inter-observer agreement of five different CT chest severity scoring systems for COVID-19 to find the most precise one with the least interpretation time. METHODS AND MATERIALS This retrospective study included 85 patients (54 male and 31 female) with PCR-confirmed COVID-19. They underwent CT to assess the severity of pulmonary involvement. Three readers were asked to assess the pulmonary abnormalities and score the severity using five different systems, including chest CT severity score (CT-SS), chest CT score, total severity score (TSS), modified total severity score (m-TSS), and 3-level chest CT severity score. Time consumption on reporting of each system was calculated. RESULTS Two hundred fifty-five observations were reported for each system. There was a statistically significant inter-observer agreement in assessing qualitative lung involvement using the m-TSS and the other four quantitative systems. The ROC curves revealed excellent and very good diagnostic accuracy for all systems when cutoff values for detection severe cases were > 22, > 17, > 12, and > 26 for CT-SS, chest CT score, TSS, and 3-level CT severity score. The AUC was very good (0.86), excellent (0.90), very good (0.89), and very good (0.86), respectively. Chest CT score showed the highest specificity (95.2%) in discrimination of severe cases. Time consumption on reporting was significantly different (< 0.001): CT-SS > 3L-CT-SS > chest CT score > TSS. CONCLUSION All chest CT severity scoring systems in this study demonstrated excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. CT-SS and TSS had the highest specificity and least time for interpretation. KEY POINTS • All chest CT severity scoring systems discussed in this study revealed excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. • Chest CT scoring system and TSS had the highest specificity. • Both TSS and m-TSS consumed the least time compared to the other three scoring systems.
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Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura, Egypt.
- Department of Radiology, Farwaniya Hospital, Kuwait City, Kuwait.
| | - Ahmad M Mounir
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | | | - Mahmoud Elsedeiq
- Department of Anesthesia and ICU, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Gehad A Saleh
- Department of Radiology, Mansoura University, Mansoura, Egypt
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Relationship of the pulmonary disease severity scoring with thromboembolic complications in COVID-19. Emerg Radiol 2021; 29:9-21. [PMID: 34802067 PMCID: PMC8605895 DOI: 10.1007/s10140-021-01998-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022]
Abstract
Purpose To correlate thromboembolic (TE) complications secondary to COVID-19 with the extent of the pulmonary parenchymal disease using CT severity scores and other comorbidities. Methods In total, 185 patients with COVID-19 and suspected thromboembolic complications were classified into two groups based on the presence or absence of thromboembolic complications. Thromboembolic complications were categorized based on location. Chest CT severity scoring system was used to assess the pulmonary parenchymal disease severity in all patients. Based into severity scores, patients were categorized into three groups (mild, moderate, and sever disease). Results The final study cohort consisted of 171 patients (99 male and 72 female) after excluding 14 patients with non-diagnostic CT pulmonary angiography. The TE group included 53 patients with a mean age of 55.1 ± 7.1, while the non-TE group included 118 patients with a mean age of 52.9 ± 10.8. Patients with BMI > 30 kg/m2 or having a history of smoking and HTN were found more frequently in the TE group (p < 0.05). Patients admitted to ICU were significantly higher in the TE group (p < 0.001). There was statistically significant difference (p = 0.002) in chest CT-SS between the TE group (22.8 ± 11.4) and non-TE group (17.6 ± 10.7). The percentage of severe parenchymal disease in the TE group was significantly higher compared to the non-TE group (p < 0.05). Severe parenchymal disease, BMI > 30 kg/m2, smoking, and HTN had a higher and more significant odds ratio for developing TE complications. Conclusion The present data suggest that severe pulmonary parenchymal disease secondary to COVID-19 is associated with a higher incidence of thromboembolic complications.
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