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Title: High-risk chest radiographic features associated with COVID-19 disease severity
Authors: Ong, Sean Wei Xiang
Hui, Terrence Chi Hong
Lee, Yeong Shyan
Haja Mohideen, Salahudeen Mohamed
Young, Barnaby Edward
Tan, Cher Heng
Lye, David Chien Boon
Keywords: Science::Medicine
Issue Date: 2021
Source: Ong, S. W. X., Hui, T. C. H., Lee, Y. S., Haja Mohideen, S. M., Young, B. E., Tan, C. H. & Lye, D. C. B. (2021). High-risk chest radiographic features associated with COVID-19 disease severity. PloS ONE, 16(1), e0245518-.
Project: COVID19RF-001 
Journal: PloS ONE 
Abstract: Objectives: High-risk CXR features in COVID-19 are not clearly defined. We aimed to identify CXR features that correlate with severe COVID-19. Methods: All confirmed COVID-19 patients admitted within the study period were screened. Those with suboptimal baseline CXR were excluded. CXRs were reviewed by three independent radiologists and opacities recorded according to zones and laterality. The primary endpoint was defined as hypoxia requiring supplemental oxygen, and CXR features were assessed for association with this endpoint to identify high-risk features. These features were then used to define criteria for a high-risk CXR, and clinical features and outcomes of patients with and without baseline high-risk CXR were compared using logistic regression analysis. Results: 109 patients were included. In the initial analysis of 40 patients (36.7%) with abnormal baseline CXR, presence of bilateral opacities, multifocal opacities, or any upper or middle zone opacity were associated with supplemental oxygen requirement. Of the entire cohort, 29 patients (26.6%) had a baseline CXR with at least one of these features. Having a high-risk baseline CXR was significantly associated with requiring supplemental oxygen in univariate (odds ratio 14.0, 95% confidence interval 3.90–55.60) and multivariate (adjusted odds ratio 8.38, 95% CI 2.43–28.97, P = 0.001) analyses. Conclusion: We identified several high-risk CXR features that are significantly associated with severe illness. The association of upper or middle zone opacities with severe illness has not been previously emphasized. Recognition of these specific high-risk CXR features is important to prioritize limited healthcare resources for sicker patients.
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0245518
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Organisations: National Centre for Infectious Diseases
Tan Tock Seng Hospital
Rights: © 2021 Ong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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