Machine-learning derived Pulmonary X-ray Severity (PXS) score to predict COVID-19 severe outcomes

Abstract

Abstract Background Using a previously validated machine learning algorithm that extracts a quantitative measure of Pulmonary Xray Severity (PXS) score. We compared lung involvement among different SARS-COV-2 variants and the association between PXS score and severe pulmonary outcomes in adult COVID-19 patients at MGH. Methods We performed a retrospective study of 8,207 COVID-19 patients who tested positive for COVID-19 by (PCR) at MGH between March 4, 2020, and February 20, 2022, and had at least one chest x-ray within ±14 days of their COVID-19 testing. Patients were categorized into three groups according to the COVID-19 waves trend in the US (Original virus, Delta variant, and Omicron variant). Unadjusted and adjusted quantile regression models were used to estimate the association between PXS scores and COVID-19 waves. While we used logistic regression models to measure the association between PXS score and ICU admission and death Results At baseline, the mean age was 56.8 ±18, 51.5% were male, and 50.4% were white. Participants in the Omicron group had lower PXS scores >9 proportions compared to Delta and Original groups (2.5% vs. 5.8% vs. 5.9 respectively, P.001). They were less likely to be admitted to the ICU compared to Delta and Original groups (3.8% vs. 5.9% vs. 6.8%, p.001). Death proportions were significantly lower in Omicron group 4% compared to Delta group 5.6% and Original group 6.3% (P.001). The adjusted ORs of association between PXS scores and ICU admission were (10.4, 12.6, 9.8, P.001) in Original, Delta and Omicron waves, respectively. While the ORs of association between PXS scores and death were (8.3, 10.3, 2.7, P.001) in the three groups. Conclusions The Omicron group was likely to have lower PXS scores than the original virus and Delta variant. Moreover, we found that patients with high PXS scores >9 have a higher likelihood of being admitted to the ICU or death compared to those with PXS scores ≤9.