Chest radiographic findings in high-risk Covid-19 pneumonia patients

Introduction: The severity of Covid-19 pneumonia has shown a positive association with co-existing risk factors. However, the exact nature of lung involvement in high-risk Covid-19 patients is yet to be resolved. Therefore, we evaluated chest X-ray (CXR) features, temporal progression, and the factors associated with CXR severity in high-risk patients.
Methods: Chest X-rays (n=289) of Covid-19 infected high-risk adults (n=228) treated at the Base Hospital Homagama were evaluated to record CXR features, their temporal progression, CXR severity score and the patient outcomes.
Results: The evaluated patients (48.2% men) were in mean age of 59 (SD 15) years. The most frequent CXR features were patchy ground-glass (GG) opacities (49%) and patchy consolidations (CON) (42%); They showed bilateral (100%) involvement, superoinferior gradient (100%) and diffuse (27%), peripheral (18%) or perihilar (10%) distribution. CON was the predominant opacity among the non-survivors and GG among the survivors (χ²=14.73; p=0.001). Right lung predominant (28%) asymmetrical lung involvement was more frequent than bilateral symmetrical (16%) or left lung predominance (7%). Progression to fatal disease was significantly higher when the lung involvement is asymmetrical: right predominance: ODDs: 0.502; p=0.023; left predominance: ODDs:0.268; p=0.002. The CXRs were frequently normal in early (66%) and progressive (56%; χ²=36.64; p<0.001) stages than in peak or resolving stages. The predictors of CXR severity included age (β : 0.140; 95% CI : 0.041 - 0.233; p=0.004), male gender (β : 4.140; 95% CI : 1.452 - 6.481; p=0.003), and disease day (β : 0.622; 95% CI : 0.301 - 0.942; p<0.001).
Conclusion: This study decoded the CXR features of Covid-19 pneumonia in a high-risk cohort while describing their associations.