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