Objectives: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support.Methods: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1–13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixiascore and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen’s kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression.Results: GGO admixed with consolidation (n= 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ= 0.90),Brixiascore (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). TheBrixiascore (OR: 1.19; 95% CI: 1.06, 1.34;p= 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22;p< 0.001), PaO₂/FiO₂ratio (OR: 0.99; 95% CI: 0.98, 1;p= 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39;p= 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03;p= 0.001) and PaO₂/FiO₂ratio (OR: 0.99; 95% CI: 0.99, 1.00;p< 0.001) were significant predictors of the need for ventilatory support.Conclusions: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO₂/FiO₂ratio, and SpO₂values to early predict mortality and the need for ventilatory support.Key Points: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia.•The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO₂/FIO₂ratio, and SpO₂values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.

Long-term pulmonary sequelae in COVID-19 patients are currently under investigation worldwide. Potential relationships between blood sampling and functional and radiological findings are crucial to guide the follow-up. In this study, we collected and evaluated clinical status, namely symptoms and patients’ reported outcome, pulmonary function tests (PFT), laboratory tests, and radiological findings at 3- and 12-months post-discharge in patients admitted between 25 February and 2 May 2020, and who survived severe COVID-19 pneumonia. A history of chronic pulmonary disease or COVID-19-unrelated complications were used as exclusion criteria. Unenhanced CTs were analyzed quantitatively (compromising lung volume %) and qualitatively, with main patterns of: ground-glass opacity (GGO), consolidation, and reticular configuration. Patients were subsequently divided into groups based on their radiological trends and according to the evolution in the percentage of compromised lung volume. At 12 months post-discharge, seventy-one patients showed significantly improved laboratory tests and PFT. Among them, 63 patients also underwent CT examination: all patients with negative CT findings at three months (n = 14) had negative CT also at 12 months; among the 49/63 patients presenting CT alterations at three months, 1/49 (2%) normalized, 40/49 (82%) improved, 7/49 (14%) remained stably abnormal, and 1/49 (2%) worsened. D-dimer values were low in patients with normal CT and higher in cases with improved or stably abnormal CT (median values 213 vs. 329 vs. 1000 ng/mL, respectively). The overall compromised lung volume was reduced compared with three months post-discharge (12.3 vs. 14.4%, p < 0.001). In stably abnormal CT, the main pulmonary pattern changed, showing a reduction in GGO and an increase in reticular configuration. To summarize, PFT are normal in most COVID-19 survivors 12 months post-discharge, but CT structural abnormalities persist (although sensibly improved over time) and are associated with higher D-dimer values.