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6th Edition of World Congress on Infectious Diseases

June 24-26, 2024 | Paris, France

June 24 -26, 2024 | Paris, France
Infection 2023

Armin Mehmedovic

Speaker at Infection Conference - Armin Mehmedovic
University Hospital for Infectious Diseases, Croatia (Hrvatska)
Title : Use of modified brixia score in predicting mortality in hospitalized patients with COVID-19 pneumonia


Purpose: To evaluate the value of modified Brixia scoring system in predicting mortality in hospitalized COVID-19 patients.

Methods and materials: An observational retrospective pilot study included 292 patients (178 male and 114 female) with PCR-confirmed COVID-19 infection hospitalized at the University Hospital for Infectious Diseases “Dr. Fran Mihaljevi?“from February 2, 2020, to December 31, 2021. Initial chest X-ray images performed at admission were analysed and scored according to the modified Brixia scoring system, having each lung divided in three zones – upper zone, middle zone, lower zone (aortic arch profile and lower profile of left pulmonary hilum being landmarks for dividing). A numerical value was added for each zone based on the morphology and extent of opacities (0 - normal lung parenchyma; 1 - interstitial involvement only; 2 - presence of radiopacity for less than 50% of the visible lung parenchyma; 3 - presence of radiopacity for 50% or more of the visible lung parenchyma, maximum value 18). Statistical analysis was done using R. Mann-Whitney U test was used to analyse differences in values of modified Brixia score in patients based on the outcome (deceased/survived).  Kruskal-Wallis test was used to determine whether there was a statistical difference in modified Brixia score between groups of patients based on the disease severity (4 categories -mild, intermediate, severe, critical).

Results: Higher values of modified Brixia score were associated with higher mortality (p<0.001), with mean value of 12 in the group of patients who died vs. 6 in the group of patients who survived.  Increased disease severity was followed by greater values of modified Brixia score (p<0.001; mean scores 5, 7, 11, 12, respectively). When comparing patients who developed acute respiratory distress syndrome (ARDS) to those who didn’t, there was a difference in values od modified Brixia score between the two groups (p<0.001; mean score 12 vs. 8, respectively). Higher values of modified Brixia score were also associated with intensive care unit admission (p<0.001) and the need for mechanical ventilation (p<0.001).

Conclusion: Modified Brixia scoring system can be useful in evaluating patients who are at increased risk for developing more severe forms of COVID-19 pneumonia which can lead to ARDS and greater mortality. Our results suggest that increasing values of modified Brixia score correlates with disease severity. However, more research is needed, preferably on a larger group of patients, to confirm our findings.

Audience take away:

  • Modified Brixia score could be useful and time-efficient tool for initial assessment of extent and severity of lung involvement in COVID-19 pneumonia, aiding clinicians in optimal patient management and potentially recognizing high risk patients that could develop ARDS
  • In our study higher values of modified Brixia score were associated with higher mortality, suggesting that it could have an important role as a predictive factor for fatal outcome
  • Due to relative simplicity of modified Brixia scoring system, it could easily be used in vast majority of clinical settings


Dr. Mehmedović studied Medicine at the School of Medicine, University of Zagreb, Croatia and graduated in 2017. He is a recipient of Dean's Commendation for academic excellence in year 2015. He worked two years as a GP in health center of Zagreb county and currently is a 3rd year radiology resident at the University Hospital for Infectious Diseases “Dr. Fran Mihaljević” and 1st year PHD student at the School of Medicine, University of Zagreb. He is a co-author of several scientific manuscripts and was awarded for the best abstract at the 8th Congress of Croatian Society of Gastroenterology, 2018, Split.