Evolution of chest radiograph radiomics and association with respiratory and inflammatory parameters in COVID-19 patients undergoing prone ventilation: Preliminary findings

The coronavirus disease 2019 (COVID-19) pandemic continues to spread internationally as deaths climb worldwide. Patients with severe disease may progress to acute respiratory distress syndrome (ARDS), often requiring mechanical ventilation. Proning may be employed for patients undergoing mechanical ventilation in order to improve oxygenation. Hospitalized COVID-19 patients are often monitored through the use of portable chest radiography (CXR). Computational modeling of CXRs has been explored in COVID-19, and radiomic features have been used to predict disease progression and severity. However, studies have not yet drawn strong connections between specific radiomic features and clinical manifestations of the disease. In this retrospective study we analyze 23 COVID-19 patients hospitalized between March and May 2020. Each of these patients underwent mechanical ventilation with proning. CXRs were taken before, during, and after proning. Clinical laboratory data including blood gas levels, severity assessment scores, serological markers for inflammation, etc. were also measured for patients before and after proning. In our analysis, 1) we identify CXR radiomic features that change significantly after proning and 2) we demonstrate correlations between radiomic features and the progression of several clinical parameters implicated in COVID-19 pathophysiology. We report statistically significant positive correlations between several radiomic features extracted from pre-proning CXRs with changes in clinical measurements of LDH, oxygen saturation, ferritin, tidal volume, arterial oxygen partial pressure (PaO2) to fraction of inspired oxygen (FIO2) ratio, and FIO2. These preliminary findings suggest that radiomic features from CXRs might reflect changes in measurable clinical variables, thus indicating the potential for portable radiography to monitor the efficacy of the proning procedure in COVID-19 patients undergoing mechanical ventilation.