Chest Roentgenogram Features in Severe COVID-19 Pneumonia Patients Admitted in ICU in a Tertiary Health Care Centre in North East India

Introduction: At the end of 2019 a highly infectious disease called coronavirus disease (COVID-19) expanded globally. Some patients progress to require ICU care. RT-PCR is the diagnostic gold standard and CT chest is the radiological investigation of choice. However, it is not always feasible to follow up ICU patients by CT scan. Chest X-ray is the most practical radiological investigation in the ICU for follow up. We evaluate the chest X-ray findings in COVID ICU patients and correlate these findings with outcome from ICU. Materials and methods: All chest X- rays of COVID-19 ICU patients were reviewed. All RT-PCR confirmed severe COVID-19 ICU patients with an outcome (discharged/deceased) were included. X-rays were analyzed according to bilaterality, mediolateral, zonal distribution and density of lung lesions. The findings were correlated with outcome from ICU. Results: 20 males and 8 females (5:2) ranging from 21 to 98 years (mean 63 years) were included. Bilateral lung involvement was seen in 23/28 cases. Involvement of 4 or more zones is higher than 3 zones or less. Ground glass in the predominant feature (19/28 cases). The ratio of the number of patients discharged to the number of deceased decreases with increasing number of zones involved(3: 1 for 1 zone to 1:5 for 6 zones) and the number of zones involved (4 or more versus 3 or less) is statistically correlated with patient?s age (p- value 0.005). Discussion: Although Chest CT is more sensitive, yet the value of chest x ray in the ICU settings cannot be overemphasized. In our study chest X-ray was able to detect lesions and prognosticate outcome from ICU. Number of zones involved correlate with the increasing age of the patient. Conclusion: Chest X-ray is an important radiological tool for follow up of severe COVID pneumonia patients under intensive critical care. Higher the possibility of poorer outcome from ICU with increasing number of zones involved.