Severity of radiographic changes in patients with COVID-19 pneumonia – experience from secondary-level hospital

Abstract

Introduction/Objective Chest X-ray (CXR) is a common diagnostic procedure for monitoring the course and outcome of pneumonia. The aim of the study was to examine the frequency, type and degree of CXR changes in COVID-19 pneumonia and compare it with demographic data and the presence of co-morbidities.

Methods In this retrospective study, CXRs taken on the day of admission were analyzed for 620 patients with COVID-19. CXR were defined as ground-glass opacification (GGO), consolidation, reticular changes, pulmonary nodules, and pleural effusions. CXR severity score (CXR-SS) was determined based on the adjusted Radiographic Assessment of Lung Edema score. SPSS version 17.0 was used for statistical analyses.

Results The average age was 62.75 ± 14.8 years 66.5% of analyzed patients had comorbidities. CXR changes were bilateral in 53.2%, dominant in the lower lung in 68.1% and diffuse in 24.5%. GGO were present in 55%, reticular changes in 37.3%, and consolidations in 24% of patients. Based on CXR-SS, 47.2% of patients had mild pneumonia, 40.2% moderate, 7.9% severe, and 4.6% very severe. Severe/very severe pneumonia was in 71.8% of older than 65 years. Bilateral changes were found in 97.4% of people with severe/very severe pneumonia, diffuse in 56.4%, and consolidation in 66.7% of the patients. GGO were in 58.1% of subjects with mild/moderate pneumonia.

Conclusion CXR in patients with COVID-19 pneumonia are more frequently bilateral, dominantly peripheral, in the lower lung zone. The degree of diffuse changes is proportional to older age and more frequent comorbidities. In a severe form of the disease, consolidation and reticular opacification dominate.

Keywords: chest X-ray; pulmonary severity score; COVID-19 pneumonia