{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:48Z","timestamp":1792787268895,"version":"4.5.0"},"reference-count":29,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"University of Pittsburgh Clinical and Translational Science Institute, COVID-19 Pilot Award","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"National Institute of Health","award":["K23 HL139987"],"award-info":[{"award-number":["K23 HL139987"]}]},{"name":"National Institute of Health","award":["R03 HL162655"],"award-info":[{"award-number":["R03 HL162655"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,12,16]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To reliably quantify the radiographic severity of COVID-19 pneumonia with the Radiographic Assessment of Lung Edema (RALE) score on clinical chest X-rays among inpatients and examine the prognostic value of baseline RALE scores on COVID-19 clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Hospitalised patients with COVID-19 in dedicated wards and intensive care units from two different hospital systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>425 patients with COVID-19 in a discovery data set and 415 patients in a validation data set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes<\/jats:title>\n                    <jats:p>We measured inter-rater reliability for RALE score annotations by different reviewers and examined for associations of consensus RALE scores with the level of respiratory support, demographics, physiologic variables, applied therapies, plasma host\u2013response biomarkers, SARS-CoV-2 RNA load and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Inter-rater agreement for RALE scores improved from fair to excellent following reviewer training and feedback (intraclass correlation coefficient of 0.85 vs 0.93, respectively). In the discovery cohort, the required level of respiratory support at the time of CXR acquisition (supplemental oxygen or non-invasive ventilation (n=178); invasive-mechanical ventilation (n=234), extracorporeal membrane oxygenation (n=13)) was significantly associated with RALE scores (median (IQR): 20.0 (14.1\u201326.7), 26.0 (20.5\u201334.0) and 44.5 (34.5\u201348.0), respectively, p&lt;0.0001). Among invasively ventilated patients, RALE scores were significantly associated with worse respiratory mechanics (plateau and driving pressure) and gas exchange metrics (PaO2\/FiO2 and ventilatory ratio), as well as higher plasma levels of IL-6, soluble receptor of advanced glycation end-products and soluble tumour necrosis factor receptor 1 (p&lt;0.05). RALE scores were independently associated with 90-day survival in a multivariate Cox proportional hazards model (adjusted HR 1.04 (1.02\u20131.07), p=0.002). We replicated the significant associations of RALE scores with baseline disease severity and mortality in the independent validation data set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With a reproducible method to measure radiographic severity in COVID-19, we found significant associations with clinical and physiologic severity, host inflammation and clinical outcomes. The incorporation of radiographic severity assessments in clinical decision-making may provide important guidance for prognostication and treatment allocation in COVID-19.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-066626","type":"journal-article","created":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T09:50:43Z","timestamp":1673517043000},"page":"e066626","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Inter-rater reliability and prognostic value of baseline Radiographic Assessment of Lung Edema (RALE) scores in observational cohort studies of inpatients with COVID-19"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-2360","authenticated-orcid":false,"given":"Nameer","family":"Al-Yousif","sequence":"first","affiliation":[{"name":"Internal Medicine Residency Program, UPMC Mercy, Pittsburgh, Pennsylvania, USA"},{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saketram","family":"Komanduri","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafiz","family":"Qurashi","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anatoliy","family":"Korzhuk","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halimat O","family":"Lawal","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Abourizk","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"},{"name":"Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin J","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Computer Vision Group, Veytel LLC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M","family":"Dietz","sequence":"additional","affiliation":[{"name":"Computer Vision Group, Veytel LLC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen K","family":"Hughes","sequence":"additional","affiliation":[{"name":"Computer Vision Group, Veytel LLC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara S","family":"Brandt","sequence":"additional","affiliation":[{"name":"Computer Vision Group, Veytel LLC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia M","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Computer Vision Group, Veytel LLC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Joyce","sequence":"additional","affiliation":[{"name":"Computer Vision Group, Veytel LLC, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa 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