Brixia Score for Predicting Mortality and Length of Stay in COVID-19 Confirmed Patients at the Hospital in Bandung

Dede Setiapriagung, Cice Tresnasari, Fajar Awalia Yulianto


On March 11, 2020, the World Health Organization declared the COVID-19 pandemic. This disease damages the lung and resulting mild to severe pneumonia. This study aimed to determine the value of the Brixia score for predicting mortality and length of stay of COVID-19 confirmed patients. The study design was case-control with secondary data from digital medical records of COVID-19 confirmed patients (December 2020 to February 2021). All patients' chest x-rays (CXR) were scored using the Brixia score. Logistic regression and the Spearman rank correlation test were used to identify mortality and length of stay predictors. There were 636 subjects included in this study, with the proportion of deceased patients (case group) being 20.3% (95% CI=17.33, 23.59%). Most CXR findings had signs of pneumonia (95.1%), including ground-glass opacities (GGOs) mixed with consolidation. The distribution of GGOs and consolidation were most frequent in the peripheral of survived patients (83.9%), while the deceased group had peripheral involvements mixed with medial (45.0%) and bilateral (22.2%). The mean Brixia score in the group of decease patients was significantly higher than the group of survived patients (11.95 vs 6.73, p=0.00). Brixia score had an OR of 1.14, 95% CI=1.07, 1.21 after adjusting by age, SpO2 level, and comorbid. The chance of dying was higher than 50% if the Brixia score reached to score of 15 (probability=49%, 95% CI=41, 56%). However, the Brixia score has no significant correlation with length of stay (rho=0.05, p=0.24). In conclusion, the CXR Brixia score can predict mortality, but it can not predict the length of stay of hospitalized COVID-19 confirmed patients.


Brixia score; COVID-19; length of stay; mortality

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Keputusan Presiden Republik Indonesia Nomor 12 Tahun 2020 tentang Penetapan Bencana Nonalam Penyebaran Corona Virus Disease 2019 (COVID-19) sebagai Bencana Nasional.

Kementerian Kesehatan Republik Indonesia. Pedoman pencegahan dan pengendalian corona virus disease (COVID-19). 4th revision [Internet]. Jakarta: Kementerian Kesehatan Republik Indonesia; 2020 March 27 [cited 2021 November 20]. Available from:

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9.

Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296(2):E32–40.

Borghesi, A, Maroldi R. COVID-19 outbreak in Italy: Experimental chest x-ray scoring system for quantifying and monitoring disease progression. Radiol Med. 2020;125(5):509–13.

Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol. 2020;21(4):494–500.

Smith DL, Grenier JP, Batte C, Spieler B. A characteristic chest radiographic pattern in the setting of the COVID-19 pandemic. Radiol Cardiothorac Imaging. 2020;2(5):e200280.

Wong HYF, Lam HYS, Fong AHT, Leung ST, Chin TWY, Lo CSY, et al. Frequency and distribution of chest radiographic findings in patients positive for COVID-19. Radiology. 2020;296(2):E72–8.

Sánchez-Oro R, Torres Nuez J, Martínez-Sanz G. Radiological findings for diagnosis of SARS-CoV-2 pneumonia (COVID-19). Med Clin (Barc). 2020;155(1):36–40.

Chen A, Huang JX, Liao Y, Liu Z, Chen D, Yang C, et al. Differences in clinical and imaging presentation of pediatric patients with COVID-19 in comparison with adults. Radiol Cardiothorac Imaging. 2020;2(2):e200117.

Smithuis R, van Delden O, Schaefer-Prokop C. HRCT - basic interpretation [Internet]. Leiden: The Radiology Assistant; 2021 [cited 2021 December 20]. Available from:

Balbi M, Caroli A, Corsi A, Milanese G, Surace A, Di Marco F, et al. Chest x-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department. Eur Radiol. 2021;31(4):1999–2012.

Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: a review. Clin Immunol. 2020;215:108427.

Shang J, Ye G, Shi K, Wan Y, Luo C, Aihara H, et al. Structural basis of receptor recognition by SARS-CoV-2. Nature. 2020;581(7807):221–4.

Attaway AH, Scheraga RG, Bhimraj A, Biehl M, Hatipoğlu U. Severe covid-19 pneumonia: pathogenesis and clinical management. BMJ. 2021;372:n436.

Macedo A, Gonçalves N, Febra C. COVID-19 fatality rates in hospitalized patients: systematic review and meta-analysis. Ann Epidemiol. 2021;57:14–21.

Vekaria B, Overton C, Wiśniowski A, Ahmad S, Aparicio-Castro A, Curran-Sebastian J, dkk. Hospital length of stay for COVID-19 patients: data-driven methods for forward planning. BMC Infect Dis. 2021;21(1):700.

Setiawati R, Widyoningroem A, Handarini T, Hayati F, Basja AT, Putri ARDS, et al. Modified chest x-ray scoring system in evaluating severity of COVID-19 patient in Dr. Soetomo General Hospital Surabaya, Indonesia. Int J Gen Med. 2021;14:2407–12.

Maroldi R, Rondi P, Agazzi GM, Ravanelli M, Borghesi A, Farina D. Which role for chest x-ray score in predicting the outcome in COVID-19 pneumonia? Eur Radiol. 2021;31(6):4016–22.

Munirathnam M, Mohan CN, Mohammadi J, Gowda SS, Ramaiah M. Determining COVID-19 disease severity and 0utcome using sequential chest radiograph in a new designated COVID-19 hospital. Int J Adv Med. 2021;8(1):98–102.

Borghesi A, Zigliani A, Golemi S, Carapella N, Maculotti P, Farina D, et al. Chest x-ray severity index as a predictor of in-hospital mortality in coronavirus disease 2019: a study of 302 patients from Italy. Int J Infect Dis. 2020;96:291–3.


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