Brixia Score as Predictor of D-Dimer Levels of COVID-19 Patients in Intensive Care Unit
Abstract
Background: COVID-19 is caused by a novel virus that can cause lung abnormalities which can be measured with new chest x-ray scoring system named Brixia score. In COVID-19 patients, coagulation disorders are often found that can be seen through D-Dimer levels. This study aimed to prove the Brixia Score as a predictor of D-Dimer levels.
Subjects and Method: This study was an observational analytic study with a cross-sectional approach. The subjects were 94 COVID-19 patients which taken from ICU Melati 1 Dr. Moewardi General Hospital, Surakarta from March 2021 to August 2021 who met the exclusion and inclusion criteria. The independent variable is the Brixia score performed by radiologists and the dependent variable is D-Dimer levels taken from laboratory results. Sampling was obtained by purposive sampling and the data were investigated using the receiver operating characteristic (ROC) curve.
Results: 94 samples were obtained for analysis. The average Brixia Score of patients with D-Dimer <2 µg/mL was Mean= 15.85; SD= 1.43 and D-Dimer ≥2 µg/mL was Mean= 17.29; SD= 0.96. There was a significant difference between the Brixia Score of patients with D-Dimer <2 µg/mL and D-Dimer ≥2 µg/mL (p<0.001). Analysis with the ROC curve shows an area under the curve (AUC) of 0.793. The optimal cutoff value of the Brixia Score for predicting D-Dimer levels was 16.5 (sensitivity 77.9%, specificity 73.1%).
Conclusion: Brixia Score proved to be a predictor of D-Dimer levels of COVID-19 patients in ICU care.
Keywords: COVID-19, ICU, brixia score, predictor, D-Dimer.
Correspondence: Widiastuti Soewondo, Radiology Department, Faculty of Medicine, Universitas Sebelas Maret. JL. Ir. Soetami No. 36A, Surakarta 57126, Indonesia. E-mail: widiastuti.sprad56@staff.uns.ac.id. Mobile: 082134368592
Indonesian Journal of Medicine (2023), 08(01): 92-99
https://doi.org/10.26911/theijmed.2023.08.01.09
References
AboHedibah SA, Tharwat N and Elmokadem AH (2021). Is chest X-Ray severity scoring for COVID-19 pneumonia reliable? Pol J Radiol. 86(1): e432–e439. doi: 10.5114/pjr.2021.108172.
Andrea L (2021). Kematian COVID19 Indonesia naik hampir 350% pada Juli 2021 databoks. Databoks.Katadata.Co.Id. Available at: https://databoks.katadata.co.id/datapublish/2021/08/06/kematiancovid19indonesianaikhampir350padajuli2021. Accessed 09 agustus 2022.
Borghesi A, Maroldi R (2020). COVID-19 outbreak in Italy: experimental chest XRay scoring system for quantifying and monitoring disease pogression. radiol med. 125(5): 509–513. doi: 10.1007/s11547020012003.
Conte G, Cei M, Evangelista I, Colombo A, Vitale J, Mazzone A, Mumoli N (2021). The meaning of D-Dimer value in COVID-19. Clin Appl Thromb Hemost. 27: 1–2. doi: 10.1177/10760296211017668.
Garg K, Namrata, Garg R, Dhanota DS, Singla N, DA P, Saggar K (2022). Correlation of chest radiological findings with biochemical markers on oxygen requirement in COVID-19 Patients: a retrospective analysis. J Clin Med Res. 03(02): 1–11. doi: 10.46889/jcmr.2022.3201.
José RJ, Williams A, Manuel A, Brown JS, Chambers RC (2020). Targeting coagulation activation in severe COVID-19 pneumonia: lessons from bacterial pneumonia and sepsis. Eur Respir Rev. 29(157): 1–12. doi: 10.1183/16000617.02402020.
Kumar S, Ghodke B (2020). D-Dimer levels in COVID-19 patients and its correlation with age and gender: a retrospective analysis. IJRR. 7(7): 339–347.
Mahardhika GS, Dharma Tedjamartono T, Buwono PW (2021). High D-Dimer and CRP levels in an asymptomatic COVID-19 patient: a case report and brief literature review. Seminar nasional riset kedokteran.
Marik PE, Deperrior SE, Ahmad Q, Dodani S (2021). Gender-based disparities in COVID-19 patient outcomes. J Investig Med. 69(4): 814–818. doi: 10.1136/jim2020001641.
Mubarak R, Esa T, Widaningsih Y and Bahrun U (2021). DDimer analysis in COVID-19 patients. Indones J Clin Pathol Med Lab. 28(1): 5–9. doi: 10.24293/ijcpml.v28i1.1812.
Munirathnam MCNM, Mohammadi J, Gowda SS, Ramaiah M (2020). Determining COVID-19 disease severity and outcome using sequential chest radiograph in a New Designated COVID-19 Hospital. Int J Adv Med. 8(1): 98102. doi: 10.18203/23493933.ijam20205480.
Ng J, Bakrania K, Russell R, Falkous C (2020). COVID-19 Mortality Rates by Age and Gender : Why Is the Disease Killing More Men than Women ? Rga, 215: 1–14. Available at: /pmc/articles/PMC7169933/?report=abstract%0Ahttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169933/%0Ahttps://www.rgare.com/docs/defaultsource/knowledgecenterarticles/covid19_mortality_age_gender.pdf?sfvrsn=5806a7ea_4. Accessed 15 november 2021.
Poudel A, Poudel Y, Adhikari A, Aryal BB, Dangol D, Bajracharya T, Maharjan A, Gautam R (2021). D-Dimer as a biomarker for assessment of COVID19 prognosis: DDimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS ONE. doi: 10.1371/journal.pone.0256744.
Rustandi D, Prihatni D, Rostini T, Tristina N (2010). Uji kesahihan (validitas) pemeriksaan D-Dimer cara menyaring kekebalan (metode imunofiltrasi) dan cara mengukur imnunotubidimetri. Indones J Clin Pathol Med Lab. 17(1): 911. doi: 10.24293/ijcpml.v17i1.1049
Soewondo W, Putro PS, Hermansah ML, Lestari L, Reviono R, Harsini H, Adhiputri A (2021). Long COVID19, radiological findings, and its management: a systematic review. Indones J Med. 6(4): 387–392. doi: 10.26911/theijmed.2021.06.04.04.
Susilo A, Rumende CM, Pitoyo CW, Santoso WD, Yulianti MSR, Singh, Nainggolan L, et al. (2020). Coronavirus disease 2019 : tinjauan literatur terkini COVID 2019. JPDI. 7(1): 45–67.
Viradanti T, Kusmala YY (2021). The relation between D-Dimer level and chest X-Ray (CXR) scoring in COVID-19 patients: proceedings of the 12th annual scientific meeting, medical faculty, Universitas Jenderal Achmad Yani, international symposium on ‘emergency preparedness and disaster response during COVID-19 pandemic’ (ASMC 2021). 37: 149–152. doi: 10.2991/ahsr.k.210723.037.
Wang P, Sha J, Meng M, Wang C, Yao Q, Zhang Z, Sun W, et al. (2020). Risk factors for severe COVID-19 in middle-aged patients without comorbidities: a multicentre retrospective study. J Transl Med. 18(1): 1–12. doi 10.1186/s12967020026558.
WHO (2021). Dashboard With Vaccination Data (no date). Available at: https://covid19. Accessed: 21 October 2021).
Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC (2020). Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID19): a review. JAMA. 324(8): 782–793. doi: 10.1001/jama.2020.12839.
Wool GD, Miller JL (2021). The Impact of COVID-19 Disease on Platelets and Coagulation. Pathobiology. 88(1): 15–27. doi: 10.1159/000512007.
WHO (2022). COVID-19 Weekly Epidemiological Update. World Health Organization. 73: 1–23. Available at: https://www.who.int/publications/m/item/covid19weeklyepidemiologicalupdate.
Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, Chen X, et al. (2020). D-Dimer as a Biomarker for Disease Severity and Mortality in COVID-19 Patients: A Case Control Study. J Intensive Care. 8(1): 1–11. doi: 10.1186/s4056002000466z.
Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, Zhang Z (2020). D-Dimer levels on admission to predict in-hospital mortality in patients with COVID19. J Thromb Haemost. 18: 1324–1329. doi: 10.1111/jth.14859.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. lancet. 395: 1054–1062. doi: 10.1016/S01406736(20)305663
