• Marco Gatti, Marco Calandri, Matteo Barba, Andrea Biondo, Carlotta Geninatti, Stephanie Gentile, Marta Greco, Vittorio Morrone, Clara Piatti, Ambra Santonocito, Sara Varello, Laura Bergamasco, Rossana Cavallo, Rosario Di Stefano, Franco Riccardini, Adriana Boccuzzi, Giorgio Limerutti, Andrea Veltri, Paolo Fonio, and Riccardo Faletti.
• Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy. marcogatti17@gmail.com.
• Radiol Med. 2020 Dec 1; 125 (12): 1271-1279.

PurposeTo assess the reliability of CXR and to describe CXR findings and clinical and laboratory characteristics associated with positive and negative CXR.MethodsRetrospective two-center study on consecutive patients admitted to the emergency department of two north-western Italian hospitals in March 2020 with clinical suspicion of COVID-19 confirmed by RT-PCR and who underwent CXR within 24 h of the swab execution. 260 patients (61% male, 62.8 ± 15.8 year) were enrolled. CXRs were rated as positive (CXR+) or negative (CXR-), and features reported included presence and distribution of airspace opacities, pleural effusion and reduction in lung volumes. Clinical and laboratory data were collected. Statistical analysis was performed with nonparametric tests, binary logistic regression (BLR) and ROC curve analysis.ResultsSensitivity of CXR was 61.1% (95%CI 55-67%) with a typical presence of bilateral (62.3%) airspace opacification, more often with a lower zone (88.7%) and peripheral (43.4%) distribution. At univariate analysis, several factors were found to differ significantly between CXR+ and CXR-. The BLR confirmed as significant predictors only lactate dehydrogenase (LDH), C-reactive protein (CRP) and interval between the onset of symptoms and the execution of CXR. The ROC curve procedure determined that CRX+ was associated with LDH > 500 UI/L (AUC = 0.878), CRP > 30 mg/L (AUC = 0.830) and interval between the onset of symptoms and the execution of CXR > 4 days (AUC = 0.75). The presence of two out of three of the above-mentioned predictors resulted in CXR+ in 92.5% of cases, whereas their absence in 7.4%.ConclusionCXR has a low sensitivity. LDH, CRP and interval between the onset of symptoms and the execution of CXR are major predictors for a positive CXR.

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