The Prognostic Capacity of the Radiographic Assessment for Lung Edema Score in Patients With COVID-19 Acute Respiratory Distress Syndrome—An International Multicenter Observational Study
Issued Date
2022-01-05
Resource Type
eISSN
2296858X
Scopus ID
2-s2.0-85123059941
Journal Title
Frontiers in Medicine
Volume
8
Rights Holder(s)
SCOPUS
Bibliographic Citation
Frontiers in Medicine Vol.8 (2022)
Suggested Citation
Valk C.M.A. The Prognostic Capacity of the Radiographic Assessment for Lung Edema Score in Patients With COVID-19 Acute Respiratory Distress Syndrome—An International Multicenter Observational Study. Frontiers in Medicine Vol.8 (2022). doi:10.3389/fmed.2021.772056 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/86207
Title
The Prognostic Capacity of the Radiographic Assessment for Lung Edema Score in Patients With COVID-19 Acute Respiratory Distress Syndrome—An International Multicenter Observational Study
Author(s)
Author's Affiliation
Faculty of Tropical Medicine, Mahidol University
Instituto de Investigación Sanitaria La Fe
Hogeschool van Amsterdam, University of Applied Sciences
Free Universities of Brussels
Hospital Universitari i Politècnic La Fe
Chonburi Regional Hospital
Università degli studi di Bari Aldo Moro
Mahidol University
Nuffield Department of Medicine
Amsterdam UMC
General Regional Hospital F. Miulli
Instituto de Investigación Sanitaria La Fe
Hogeschool van Amsterdam, University of Applied Sciences
Free Universities of Brussels
Hospital Universitari i Politècnic La Fe
Chonburi Regional Hospital
Università degli studi di Bari Aldo Moro
Mahidol University
Nuffield Department of Medicine
Amsterdam UMC
General Regional Hospital F. Miulli
Other Contributor(s)
Abstract
Background: The radiographic assessment for lung edema (RALE) score has an association with mortality in patients with acute respiratory distress syndrome (ARDS). It is uncertain whether the RALE scores at the start of invasive ventilation or changes thereof in the next days have prognostic capacities in patients with COVID-19 ARDS. Aims and Objectives: To determine the prognostic capacity of the RALE score for mortality and duration of invasive ventilation in patients with COVID-19 ARDS. Methods: An international multicenter observational study included consecutive patients from 6 ICUs. Trained observers scored the first available chest X-ray (CXR) obtained within 48 h after the start of invasive ventilation (“baseline CXR”) and each CXRs thereafter up to day 14 (“follow-up CXR”). The primary endpoint was mortality at day 90. The secondary endpoint was the number of days free from the ventilator and alive at day 28 (VFD-28). Results: A total of 350 CXRs were scored in 139 patients with COVID-19 ARDS. The RALE score of the baseline CXR was high and was not different between survivors and non-survivors (33 [24–38] vs. 30 [25–38], P = 0.602). The RALE score of the baseline CXR had no association with mortality (hazard ratio [HR], 1.24 [95% CI 0.88–1.76]; P = 0.222; area under the receiver operating characteristic curve (AUROC) 0.50 [0.40–0.60]). A change in the RALE score over the first 14 days of invasive ventilation, however, had an independent association with mortality (HR, 1.03 [95% CI 1.01–1.05]; P < 0.001). When the event of death was considered, there was no significant association between the RALE score of the baseline CXR and the probability of being liberated from the ventilator (HR 1.02 [95% CI 0.99–1.04]; P = 0.08). Conclusion: In this cohort of patients with COVID-19 ARDS, with high RALE scores of the baseline CXR, the RALE score of the baseline CXR had no prognostic capacity, but an increase in the RALE score in the next days had an association with higher mortality.