Role of a Chest X-ray Severity Score in a Multivariable Predictive Model for Mortality in Patients with COVID-19: A Single-Center, Retrospective Study

Predicting the mortality risk of patients with Coronavirus Disease 2019 (COVID-19) can be valuable in allocating limited medical resources in the setting of outbreaks. This study assessed the role of a chest X-ray (CXR) scoring system in a multivariable model in predicting the mortality of COVID-19 patients by performing a single-center, retrospective, observational study including consecutive patients admitted with a confirmed diagnosis of COVID-19 and an initial CXR. The CXR severity score was calculated by three radiologists with 12 to 15 years of experience in thoracic imaging, based on the extent of lung involvement and density of lung opacities. Logistic regression analysis was used to identify independent predictive factors for mortality to create a predictive model. A validation dataset was used to calculate its predictive value as the AUROC. A total of 628 patients (58.1% male) were included in this study. Age ( \u3c 0.001), sepsis ( \u3c 0.001), S/F ratio ( \u3c 0.001), need for mechanical ventilation ( \u3c 0.001), and the CXR severity score ( = 0.005) were found to be independent predictive factors for mortality. We used these variables to develop a predictive model with an AUROC of 0.926 (0.891, 0.962), which was significantly higher than that of the WHO COVID severity classification, 0.853 (0.798, 0.909) (one-tailed -value = 0.028), showing that our model can accurately predict mortality of hospitalized COVID-19 patients

A possible case of cherubism in a 17th-century Korean mummy.

Cherubism is a benign fibro-osseous disease of childhood limited specifically to the maxilla and mandible. The progressive replacement of the jaw bones with expansile multilocular cystic lesions causes eventual prominence of the lower face, and hence the classic "cherubic" phenotype reflecting variable extents of jaw hypertrophy. Histologically, this condition has been characterized as replacement of the normal bone matrix with multicystic pockets of fibrous stroma and osteoclastic giant cells. Because of radiographic features common to both, primarily the presence of multiloculated lucencies with heterogeneous "ground-glass" sclerosis on CT imaging, cherubism was long mistaken for a craniofacial subtype of fibrous dysplasia. In 1999, however, the distinct genetic basis for cherubism was mapped to chromosome 4p16.3 and the SH-3 binding protein SH3BP2. But while there are already three suspected cases of fibrous dysplasia amongst archaeological populations, no definitive cases of cherubism have yet been reported in historical populations. In the current study we describe micro- and macro-structural changes in the face of a 17th century Joseon Dynasty Korean mummy which may coincide with the clinic-pathologic and radiologic features of cherubism

The head of the Hadong I mummy.

<p>(a) Overview of the head demonstrates prominent diffuse expansion of the lower portion of the face. (b) Section through the maxillary sinus. Note the hypertrophic zygomaxillary area (which results in the classic swollen-cheeked phenotype in living patients), thickened orbital floor (which results in upturned eyes in the living), cortical thinning, whorled pattern of the woven bone, and deformity of the maxillary sinus.</p

The coffin of the mummy.

<p>Note that the coffin was encapsulated by lime and was of the double type, namely an external wooden coffin and internal lead coffin.</p

Electron microscope images of the sectioned area shown in Fig. 12.

<p>The brownish material seen in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0102441#pone-0102441-g012" target="_blank">figure 12</a> represents bony trabeculae. Hydroxyapatite crystals are oriented parallel to the long axis of irregularly arranged collagen fibers (A and arrows in B). The whitish material seen in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0102441#pone-0102441-g012" target="_blank">Fig. 12</a> is amorphous in nature and composed of both organic and inorganic material (C and D).</p

H&E stained histological sections of the maxillary sinus wall.

<p>(B) is a magnified image of (A). Intensely stained (trabecular bone) and weakly stained areas (amorphous material) are distinctly seen. Note the “C-shaped” trabeculae of the woven bone (orange circles) dispersed within the lightly stained stroma.</p

Surface and chemical analysis of the maxillary sinus wall.

<p><b>A.</b> Surface and chemical analyses of bone section from the zygomaxillary area using ESEM. Backscattered electron image (left) - bright phases on the backscattered image composed, based on X-ray EDS spectra, of bony material (a =  bone trabeculae), dull phases (b =  cysts filled with partially calcified fibrous tissue), mainly of organic material. Noteworthy is the relatively high concentration of organic material within the bony trabeculae (right top) and the presence of calcite crystals coating some of the organic material (bottom right). “C” and “Y”-shaped trabeculae are clearly visible. <b>B.</b> SEM clearly showing that the “brownish” parts (a and b) are composed of bony trabeculae, whereas the “whitish” part (c and d) contains crystals admixed with organic material.</p

Low magnification of the sectioned area demonstrates amorphous islands of white material occupying the spaces between the brownish material.

<p>Low magnification of the sectioned area demonstrates amorphous islands of white material occupying the spaces between the brownish material.</p

Histological section (H&E staining) shows cysts filled with fibrous tissue and crystals (a) and surrounded by bony spiculae (b).

<p>Histological section (H&E staining) shows cysts filled with fibrous tissue and crystals (a) and surrounded by bony spiculae (b).</p

Anthropometric data.

<p>Anthropometric data.</p