{"doi":"10.1101/2022.06.10.22276249","title":"Radiographic Assessment of Lung Edema (RALE) Scores are Highly Reproducible and Prognostic of Clinical Outcomes for Inpatients with COVID-19","abstract":"INTRODUCTION: Chest imaging is necessary for diagnosis of COVID-19 pneumonia, but current risk stratification tools do not consider radiographic severity. We quantified radiographic heterogeneity among inpatients with COVID-19 with the Radiographic Assessment of Lung Edema (RALE) score on Chest X-rays (CXRs). METHODS: We performed independent RALE scoring by ≥2 reviewers on baseline CXRs from 425 inpatients with COVID-19 (discovery dataset), we recorded clinical variables and outcomes, and measured plasma host-response biomarkers and SARS-CoV-2 RNA load from subjects with available biospecimens. RESULTS: We found excellent inter-rater agreement for RALE scores (intraclass correlation co-efficient=0.93). The required level of respiratory support at the time of baseline CXRs (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 [interquartile range]: 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, sRAGE and TNFR1 levels (p<0.05). RALE scores were independently associated with 90-day survival in a multivariate Cox proportional hazards model (adjusted hazard ratio 1.04[1.02-1.07], p=0.002). We validated significant associations of RALE scores with baseline severity and mortality in an independent dataset of 415 COVID-19 inpatients. CONCLUSION: Reproducible assessment of radiographic severity revealed significant associations with clinical and physiologic severity, host-response biomarkers and clinical outcome in COVID-19 pneumonia. Incorporation of radiographic severity assessments may provide prognostic and treatment allocation guidance in patients hospitalized with COVID-19.","journal":"medRxiv","year":2022,"id":298717,"datarank":0.26876392038420827,"base_score":1.791759469228055,"endowment":1.791759469228055,"self_citation_contribution":0.26876392038420827,"citation_network_contribution":0.0,"self_endowment_contribution":0.26876392038420827,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9511,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":988065,"name":"Saketram Komanduri","orcid":"0000-0003-1910-9420","position":1,"is_corresponding":false},{"id":988664,"name":"Hafiz Qurashi","orcid":null,"position":2,"is_corresponding":false},{"id":988066,"name":"Anatoliy Korzhuk","orcid":"0000-0001-5936-9628","position":3,"is_corresponding":false},{"id":988665,"name":"Halimat Lawal","orcid":null,"position":4,"is_corresponding":false},{"id":988666,"name":"Nicholas Abourizk","orcid":null,"position":5,"is_corresponding":false},{"id":375424,"name":"Caitlin Schaefer","orcid":null,"position":6,"is_corresponding":false},{"id":988067,"name":"Kevin J. Mitchell","orcid":"0000-0002-1870-5522","position":7,"is_corresponding":false},{"id":988068,"name":"Catherine M. Dietz","orcid":"0000-0002-7672-7973","position":8,"is_corresponding":false},{"id":988069,"name":"Ellen K. Hughes","orcid":"0000-0001-7253-4552","position":9,"is_corresponding":false},{"id":988667,"name":"Clara S. Brandt","orcid":null,"position":10,"is_corresponding":false},{"id":988668,"name":"Georgia M. Fitzgerald","orcid":null,"position":11,"is_corresponding":false},{"id":343825,"name":"Robin Joyce","orcid":"0000-0002-7251-8082","position":12,"is_corresponding":false},{"id":988669,"name":"Asmaa S. Chaudhry","orcid":null,"position":13,"is_corresponding":false},{"id":315811,"name":"Daniel Kotok","orcid":null,"position":14,"is_corresponding":false},{"id":988670,"name":"Jose D. Rivera","orcid":null,"position":15,"is_corresponding":false},{"id":988671,"name":"Andrew I. 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