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

• Published in: PloS one Vol. 17; no. 6; p. e0270111
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16-06-2022; Public Library of Science (PLoS)
• Subjects: Age; Biology and Life Sciences; Blood; C-reactive protein; Cohort analysis; Comorbidity; Computed tomography; Coronaviruses; COVID-19; Critical care; Diabetes; Diagnostic imaging; Edema; Emergency medical care; Emergency medical services; Health surveillance; Hospitals; Information systems; Italy; Laboratories; Medical imaging; Medical prognosis; Medical research; Medicine and Health Sciences; Medicine, Experimental; Methods; Modelling; Mortality; Oxygen; Oxygen content; Pandemics; Patient admissions; Physical Sciences; Pneumonia; Regression analysis; Research and Analysis Methods; Saturation; Severe acute respiratory syndrome coronavirus 2; Sex; Sulfur dioxide; Time measurement; Visual discrimination; X-rays; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0270111

COVID-19 prognostic factors include age, sex, comorbidities, laboratory and imaging findings, and time from symptom onset to seeking care.
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).
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.
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.
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.