• Will Sargent, Sajeed Ali, Sebi Kukran, Miranda Harvie, and Susanne Soin.
• Ealing Hospital, London, UK william.sargent@nhs.net.
• Clin Med (Lond). 2021 Jan 1; 21 (1): e14e19e14-e19.

ObjectiveThe objective was to explore if chest X-ray severity, assessed using a validated scoring system, predicts patient outcome on admission and when starting continuous positive pressure ventilation (CPAP) for COVID-19.DesignThe study was a retrospective case-controlled study.ParticipantsThere were 163 patients with COVID-19 deemed candidates for CPAP on admission, including 58 who subsequently required CPAP.Outcome MeasuresOn admission, we measured the proportion of patients meeting a composite 'negative' outcome of requiring CPAP, intubation or dying versus successful ward-based care. For those escalated to CPAP, 'negative' outcomes were intubation or death versus successful de-escalation of respiratory support.ResultsOur results were stratified into tertiles, those with 'moderate' or 'severe' X-rays on admission had significantly higher odds of negative outcome versus 'mild' (odds ratio (OR) 2.32; 95% confidence interval (CI) 1.121-4.803; p=0.023; and OR 3.600; 95% CI 1.681-7.708; p=0.001, respectively). This could not be demonstrated in those commencing CPAP (OR 0.976; 95% CI 0.754-1.264; p=0.856).ConclusionsWe outline a scoring system to stratify X-rays by severity and directly link this to prognosis. However, we were unable to demonstrate this association in the patients commencing CPAP.© Royal College of Physicians 2021. All rights reserved.

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