Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19.
Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19.
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DOI：
10.1136/bmjopen-2022-066626
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发表时间：
2023-01-12
期刊：
影响因子：
2.9
通讯作者：
中科院分区：
文献类型：
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作者：
通过住院患者临床胸部X线的肺水肿放射学评估（RALE）评分可靠地量化COVID-19肺炎的放射学严重程度，并检查基线RALE评分对COVID-19临床结局的预后价值。来自两个不同医院系统的COVID-19患者在专用病房和重症监护室住院。发现数据集中的425名COVID-19患者和验证数据集中的415名患者。我们测量了不同评价者对RALE评分注释的评分者间可靠性，并检查了共识RALE评分与呼吸支持水平、人口统计学、生理变量、应用的治疗、血浆宿主反应生物标志物、SARS-CoV-2 RNA载量和临床结局的相关性。在评审员培训和反馈后，RALE评分的评定者间一致性从一般提高到优秀（组内相关系数分别为0.85和0.93）。在发现队列中，采集CXR时所需的呼吸支持水平（辅助供氧或无创通气（n=178）;有创机械通气（n=234），体外膜肺氧合（n=13））与RALE评分显著相关（中位数（IQR）：分别为20.0（14.1-26.7）、26.0（20.5-34.0）和44.5（34.5-48.0），p<0.0001）。在有创通气患者中，RALE评分与较差的呼吸力学（平台和驱动压）和气体交换指标（PaO 2/FiO 2和舒张比）以及较高的血浆IL-6、可溶性晚期糖基化终产物受体和可溶性肿瘤坏死因子受体1水平显著相关（p<0.05）。在多变量考克斯比例风险模型中，RALE评分与90天生存率独立相关（校正HR 1.04（1.02-1.07），p=0.002）。我们在独立验证数据集中重复了RALE评分与基线疾病严重程度和死亡率的显著相关性。通过一种可重复的方法来测量COVID-19的放射学严重程度，我们发现了与临床和生理严重程度、宿主炎症和临床结局的显著相关性。在临床决策中纳入放射学严重程度评估可能为COVID-19的诊断和治疗分配提供重要指导。
To reliably quantify the radiographic severity of COVID-19 pneumonia with the Radiographic Assessment of Lung Edema (RALE) score on clinical chest X-rays among inpatients and examine the prognostic value of baseline RALE scores on COVID-19 clinical outcomes. Hospitalised patients with COVID-19 in dedicated wards and intensive care units from two different hospital systems. 425 patients with COVID-19 in a discovery data set and 415 patients in a validation data set. We measured inter-rater reliability for RALE score annotations by different reviewers and examined for associations of consensus RALE scores with the level of respiratory support, demographics, physiologic variables, applied therapies, plasma host–response biomarkers, SARS-CoV-2 RNA load and clinical outcomes. Inter-rater agreement for RALE scores improved from fair to excellent following reviewer training and feedback (intraclass correlation coefficient of 0.85 vs 0.93, respectively). In the discovery cohort, the required level of respiratory support at the time of CXR acquisition (supplemental oxygen or non-invasive ventilation (n=178); invasive-mechanical ventilation (n=234), extracorporeal membrane oxygenation (n=13)) was significantly associated with RALE scores (median (IQR): 20.0 (14.1–26.7), 26.0 (20.5–34.0) and 44.5 (34.5–48.0), respectively, p<0.0001). Among invasively ventilated patients, RALE scores were significantly associated with worse respiratory mechanics (plateau and driving pressure) and gas exchange metrics (PaO2/FiO2 and ventilatory ratio), as well as higher plasma levels of IL-6, soluble receptor of advanced glycation end-products and soluble tumour necrosis factor receptor 1 (p<0.05). RALE scores were independently associated with 90-day survival in a multivariate Cox proportional hazards model (adjusted HR 1.04 (1.02–1.07), p=0.002). We replicated the significant associations of RALE scores with baseline disease severity and mortality in the independent validation data set. With a reproducible method to measure radiographic severity in COVID-19, we found significant associations with clinical and physiologic severity, host inflammation and clinical outcomes. The incorporation of radiographic severity assessments in clinical decision-making may provide important guidance for prognostication and treatment allocation in COVID-19.
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影响因子：
9.2
作者：
Cushnan D;Bennett O;Berka R;Bertolli O;Chopra A;Dorgham S;Favaro A;Ganepola T;Halling-Brown M;Imreh G;Jacob J;Jefferson E;Lemarchand F;Schofield D;Wyatt JC;NCCID Collaborative
通讯作者：
NCCID Collaborative
DOI：
10.5811/westjem.2020.7.48842
发表时间：
2020-08-17
期刊：
The western journal of emergency medicine
影响因子：
--
作者：
Kerpel A;Apter S;Nissan N;Houri-Levi E;Klug M;Amit S;Konen E;Marom EM
通讯作者：
Marom EM
影响因子：
3.7
作者：
Kotok, Daniel;Yang, Libing;Kitsios, Georgios D.
通讯作者：
Kitsios, Georgios D.
DOI：
10.1016/s2213-2600(19)30369-8
发表时间：
2020-03
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Sinha P;Delucchi KL;McAuley DF;O'Kane CM;Matthay MA;Calfee CS
通讯作者：
Calfee CS
影响因子：
4.6
作者：
Ebrahimian S;Homayounieh F;Rockenbach MABC;Putha P;Raj T;Dayan I;Bizzo BC;Buch V;Wu D;Kim K;Li Q;Digumarthy SR;Kalra MK
通讯作者：
Kalra MK