Dataset Information

Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19.

ABSTRACT:

Objectives

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.

Setting

Hospitalised patients with COVID-19 in dedicated wards and intensive care units from two different hospital systems.

Participants

425 patients with COVID-19 in a discovery data set and 415 patients in a validation data set.

Primary and secondary outcomes

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.

Results

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.

Conclusions

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.

SUBMITTER: Al-Yousif N

PROVIDER: S-EPMC9842602 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19.

Al-Yousif Nameer N Komanduri Saketram S Qurashi Hafiz H Korzhuk Anatoliy A Lawal Halimat O HO Abourizk Nicholas N Schaefer Caitlin C Mitchell Kevin J KJ Dietz Catherine M CM Hughes Ellen K EK Brandt Clara S CS Fitzgerald Georgia M GM Joyce Robin R Chaudhry Asmaa S AS Kotok Daniel D Rivera Jose D JD Kim Andrew I AI Shettigar Shruti S Lavina Allen A Girard Christine E CE Gillenwater Samantha R SR Hadeh Anas A Bain William W Shah Faraaz A FA Bittner Matthew M Lu Michael M Prendergast Niall N Evankovich John J Golubykh Konstantin K Ramesh Navitha N Jacobs Jana J JJ Kessinger Cathy C Methe Barbara B Lee Janet S JS Morris Alison A McVerry Bryan J BJ Kitsios Georgios D GD

BMJ open 20230112 1

<h4>Objectives</h4>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.<h4>Setting</h4>Hospitalised patients with COVID-19 in dedicated wards and intensive care units from two different hospital systems.<h4>Participants</h4>425 patients with COVID-19 in a discovery data set and 415 patients in ...[more]

PMID: 36635036

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Project description:BackgroundThe statistical validities of the official Japanese classifications of activities of daily living (ADLs), including bedriddenness ranks (BR) and cognitive function scores (CFS), have yet to be assessed. To this aim, we evaluated the ability of BR and CFS to assess ADLs using inter-rater reliability and criterion-related validity.MethodsNew inpatients aged ≥75 years were enrolled in this hospital-based prospective observational study. BR and CFS were assessed once by an attending nurse, and then by a social worker/medical clerk. We evaluated inter-rater reliability between different professions by calculating the concordance rate, kappa coefficient, Cronbach's α, and intraclass correlation coefficient. We also estimated the relationship of the Barthel Index and Katz Index with the BR and CFS using Spearman's correlation coefficients.ResultsFor the 271 patients enrolled, BR at the first assessment revealed 66 normal, 10 of J1, 15 of J2, 18 of A1, 31 of A2, 37 of B1, 35 of B2, 22 of C1, and 32 of C2. The concordance rate between the two BR assessments was 68.6%, with a kappa coefficient of 0.61, Cronbach's α of 0.91, and an intraclass correlation coefficient of 0.83, thus showing good inter-rater reliability. BR was negatively correlated with the Barthel Index (r = - 0.848, p < 0.001) and Katz Index (r = - 0.820, p < 0.001), showing justifiable criterion-related validity. Meanwhile, CFS at the first assessment revealed 92 normal, 47 of 1, 19 of 2a, 30 of 2b, 60 of 3a, 8 of 3b, 8 of 4, and 0 of M. The concordance rate between the two CFS assessments was 70.1%, with a kappa coefficient of 0.62, Cronbach's α of 0.87, and an intraclass correlation coefficient 0.78, thus also showing good inter-rater reliability. CFS was negatively correlated with the Barthel Index (r = - 0.667, p < 0.001) and Katz Index (r = - 0.661, p < 0.001), showing justifiable criterion-related validity.ConclusionsBR and CFS could be reliable and easy-to-use grading scales of ADLs in acute clinical practice or large-scale screening, with high inter-rater reliabilities among different professions and significant correlations with well-established, though complicated to use, instruments to assess ADLs.Trial registrationUMIN000041051 (2020/7/10).

Dataset Information

Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19.

Objectives

Setting

Participants

Primary and secondary outcomes

Results

Conclusions

Publications

Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19.

Similar Datasets

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