Coronavirus Disease-2019 Pneumonia: Severity and distribution of lung changes observed on the initial chest X-ray as an indicator of final outcomes

Objectives: The aim of this study is to assess the correlation between the severity of the initial chest x-ray abnormalities in patients with confirmed diagnosis of coronavirus disease 2019 (COVID-19) and the final outcomes. Methods: Retrospectively, we identified serial chest radiographs of 64 patients (57 men, 7 women, with mean age of 50 years) admitted to the Royal Hospital between March 15, 2020 and May 30, 2020 with confirmed diagnosis of COVID-19. The chest radiographs were examined for presence, extent, distribution and progression pattern of radiological abnormalities. Each lung field was divided into 3 zones on each CXR and a score was allocated for each zone. The scores (0 [normal], 1 [mild] to 4 [severe]) for all six zones per chest radiographic examination were summed to provide a cumulative chest radiographic score (range, 0–24). Results: The initial CXR was abnormal in 60 patients (93.8%). The most common finding was ground glass opacity (58/64, 90.6%), followed by consolidation (50/64, 78.1%). The majority of the patients had bilateral (51/64, 85%), multifocal (57/64 95%) combined central and peripheral (36/64, 60%) lung abnormalities. The median score of initial CXR for deceased patients was significantly higher than those who recovered (17 vs 11 respectively; P = 0.009). Five CXR evolution patterns were identified: type I (initial radiograph deteriorates then improves), type II (fluctuate), type III (static), type IV (progressive deterioration) and type V (progressive improvement). Conclusion: Higher baseline chest radiograph score is associated with higher mortality rate and poor prognosis in those with COVID-19 pneumonia. Keywords: SARS-CoV-2; COVID-19; Chest X-ray; Scoring System; Pneumonia; Prognosis; Outcome; Severity; Consolidation; Ground-glass.