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Neumonía COVID-19: relación entre la radiografía de tórax inicial y los datos analíticos
COVID-19 pneumonia: relationship between initial chest X-rays and laboratory findings
Á. Nava-Muñoza,
Autor para correspondencia
angelitonava@gmail.com

Autor para correspondencia.
, S. Gómez-Peñaa, M.E. Fuentes-Ferrerb, B. Cabezaa, A. Victoriaa, A. Bustosc
a Servicio de Radiología, Hospital Clínico Universitario San Carlos, Madrid, España
b Servicio de Medicina Preventiva, Hospital Clínico Universitario San Carlos, Madrid, España
c Jefe de Sección de Radiología de Tórax Hospital Clínico Universitario San Carlos, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0275" class="elsevierStylePara elsevierViewall">El 31 de diciembre de 2019 se comunicaron a la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; numerosos casos de una neumon&#237;a de etiolog&#237;a desconocida detectados en Wuhan &#40;China&#41;&#46; El agente causante de esta neumon&#237;a fue identificado como un nuevo virus de la familia <span class="elsevierStyleItalic">Coronaviridae</span> que posteriormente se ha denominado SARS-CoV-2 &#40;coronavirus tipo 2 del s&#237;ndrome respiratorio agudo grave&#41;&#46; El cuadro cl&#237;nico asociado a este virus se ha denominado COVID-19 &#40;enfermedad por coronavirus 2019&#41;&#46; El 30 de enero de 2020&#44; la OMS declar&#243; la COVID-19 una emergencia de salud p&#250;blica de importancia internacional y el 12 de marzo fue declarada pandemia<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Hasta la fecha&#44; en Espa&#241;a &#40;18 de diciembre de 2020&#41; se han comunicado 1&#46;797&#46;236 casos confirmados y 48 926 fallecimientos<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El espectro cl&#237;nico de la COVID-19 var&#237;a desde formas asintom&#225;ticas hasta formas graves con distr&#233;s respiratorio del adulto y muerte&#46; Las manifestaciones cl&#237;nicas m&#225;s frecuentemente descritas son fiebre&#44; tos&#44; mialgias&#44; cefaleas y disnea<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a>&#46; En pacientes ingresados&#44; la enfermedad grave o mortal es m&#225;s frecuente<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La mayor&#237;a de las publicaciones radiol&#243;gicas sobre la COVID-19 se centraron en un principio en los hallazgos en la tomograf&#237;a computarizada &#40;TC&#41; de t&#243;rax&#44; ya que en China se empez&#243; a utilizar como t&#233;cnica de primera l&#237;nea dada su elevada sensibilidad<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a>&#46; Posteriormente&#44; el American College of Radiology &#40;ACR&#41;&#44; la Society of Thoracic Radiology &#40;STR&#41; y la American Society of Emergency Radiology &#40;ASER&#41; desaconsejaron el uso sistem&#225;tico de la TC tor&#225;cica como t&#233;cnica de cribado o de primera elecci&#243;n en el diagn&#243;stico de pacientes con sospecha de COVID-19<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a>&#46; Kim et al&#46; confirman&#44; en un metaan&#225;lisis&#44; que fuera de China&#44; donde hay una baja prevalencia de la COVID-19 &#40;1-22&#44;9&#37;&#41;&#44; la TC de t&#243;rax en pacientes con sospecha cl&#237;nica de COVID-19 tiene un valor predictivo positivo bajo &#40;1&#44;5-30&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a>&#46; En otro metaan&#225;lisis m&#225;s reciente Xu et al&#46; concluyen que en general la TC de t&#243;rax tiene buena sensibilidad para detectar la neumon&#237;a COVID-19&#44; especialmente en aquellas regiones con una situaci&#243;n epid&#233;mica grave&#44; y es de ayuda para detectar casos sospechosos en fases tempranas&#46; Por el contrario&#44; la especificidad es relativamente baja &#40;25-33&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La radiograf&#237;a de t&#243;rax es menos sensible que la TC y por ello puede ser normal en las fases iniciales de la COVID-19&#44; pero es una t&#233;cnica &#250;til&#44; r&#225;pida&#44; ampliamente disponible y f&#225;cil de realizar&#46; En la mayor&#237;a de los casos ha sido la &#250;nica t&#233;cnica radiol&#243;gica que se ha realizado a estos pacientes<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a>&#46; Sin embargo&#44; la radiograf&#237;a de t&#243;rax presenta una amplia variabilidad interobservador&#46; Para intentar paliar este hecho se han utilizado diferentes m&#233;todos objetivos que valoran la extensi&#243;n y gravedad de la afectaci&#243;n pulmonar&#46; Por ejemplo&#44; el &#237;ndice de gravedad del edema pulmonar <span class="elsevierStyleItalic">&#40;</span>RALE&#41; fue &#250;til a la hora de cuantificar la extensi&#243;n del distr&#233;s respiratorio del adulto<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; M&#225;s recientemente se han utilizado tambi&#233;n diferentes sistemas de puntuaci&#243;n tanto para la TC como para la radiograf&#237;a de t&#243;rax&#44; que cuantifican la afectaci&#243;n pulmonar en los enfermos con COVID-19<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11&#8211;16</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se han publicado hasta el momento muy pocos estudios que relacionen la cuantificaci&#243;n de la gravedad de los hallazgos radiol&#243;gicos en la radiograf&#237;a de t&#243;rax con los datos anal&#237;ticos<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;17</span></a>&#46; Los principales par&#225;metros anal&#237;ticos que se han relacionado con la gravedad de la neumon&#237;a COVID-19 y la evoluci&#243;n de los pacientes son el aumento de la prote&#237;na C reactiva &#40;PCR&#41;&#44; del d&#237;mero-D y de la enzima lactato deshidrogenasa &#40;LDH&#41; y la linfopenia<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es valorar si existe una relaci&#243;n entre los hallazgos en la radiograf&#237;a de t&#243;rax y la cuantificaci&#243;n de su gravedad&#44; con los datos anal&#237;ticos en el momento del diagn&#243;stico y con el tiempo transcurrido desde el inicio de los s&#237;ntomas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio descriptivo&#44; transversal&#44; retrospectivo y unic&#233;ntrico&#46; Este estudio fue aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n Cl&#237;nica de nuestro centro&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Poblaci&#243;n de estudio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se incluyeron consecutivamente todos los pacientes sintom&#225;ticos&#44; mayores de edad&#44; que acudieron a nuestro centro entre el 29 de febrero y el 23 de marzo de 2020&#44; con una prueba RT-PCR &#40;reacci&#243;n en cadena de la polimerasa con transcriptasa inversa&#41; nasofar&#237;ngea positiva para SARS-CoV-2 y una radiograf&#237;a de t&#243;rax y anal&#237;tica en sangre al diagn&#243;stico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Fueron excluidos aquellos pacientes con una RT-PCR positiva&#44; pero sin radiograf&#237;a de t&#243;rax al diagn&#243;stico&#44; aquellos sin anal&#237;tica inicial y aquellos en cuya anal&#237;tica inicial no estaban presentes estos cinco par&#225;metros&#58; recuento de leucocitos&#44; linfocitos y plaquetas&#44; el cociente linfocitos&#47;leucocitos y la PCR &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de estudio</span><p id="par0050" class="elsevierStylePara elsevierViewall">Todos los datos se obtuvieron de las historias cl&#237;nicas de los pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables de resultado primarias</span><p id="par0055" class="elsevierStylePara elsevierViewall">Son los hallazgos radiol&#243;gicos en la radiograf&#237;a de t&#243;rax inicial&#44; la cuantificaci&#243;n de su extensi&#243;n &#40;<span class="elsevierStyleItalic">score</span> o &#237;ndice de gravedad radiogr&#225;fico&#41; y su correlaci&#243;n con los datos anal&#237;ticos iniciales&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En las radiograf&#237;as de t&#243;rax se valoraron los siguientes hallazgos&#58; opacidades en vidrio deslustrado&#44; consolidaciones&#44; opacidades lineales&#44; derrame pleural&#44; adenopat&#237;as&#44; fibrosis pulmonar por patolog&#237;a pulmonar previa&#44; enfisema y n&#243;dulos&#47;masas&#46; Se siguieron los criterios de la Sociedad Fleischner para definir los hallazgos radiol&#243;gicos<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#46; En el caso de que presentaran opacidades en vidrio deslustrado o consolidaciones pulmonares se recogi&#243; su distribuci&#243;n&#58; central &#40;en los dos tercios internos del pulm&#243;n&#41;&#44; perif&#233;rica &#40;en el tercio externo&#41;&#44; o difusa&#44; con afectaci&#243;n de ambas&#46; Asimismo&#44; se valor&#243; qu&#233; campos pulmonares se encontraban afectados &#40;superior&#44; medio e inferior en cada pulm&#243;n&#41; y si las lesiones eran uni- o bilaterales&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Con el fin de graduar la extensi&#243;n de la afectaci&#243;n pulmonar &#40;&#237;ndice de gravedad radiogr&#225;fico&#41;&#44; cada pulm&#243;n se dividi&#243; en tres campos separados por dos l&#237;neas horizontales&#58; una superior a la altura del borde inferior del cayado a&#243;rtico y otra inferior a la altura de las venas pulmonares<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">13&#44;15</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La cuantificaci&#243;n de la extensi&#243;n de la afectaci&#243;n pulmonar se obtuvo sumando la puntuaci&#243;n en cada campo pulmonar &#40;0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>normal y 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>con afectaci&#243;n&#41;&#44; obteni&#233;ndose una puntuaci&#243;n global para ambos pulmones entre 0 y 6&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">En cuanto a los datos de laboratorio iniciales correspondientes a la primera radiograf&#237;a de t&#243;rax&#44; se recogieron el recuento de leucocitos&#44; de linfocitos y su porcentaje&#44; de plaquetas&#44; la PCR&#44; el d&#237;mero&#160;D&#44; la enzima lactato deshidrogenasa &#40;LDH&#41;&#44; la ferritina y la enzima creatina cinasa &#40;CK&#41;&#46; El tiempo transcurrido entre la anal&#237;tica sangu&#237;nea y la radiograf&#237;a de t&#243;rax no super&#243; en ning&#250;n caso las 24 horas&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables independientes</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los datos antropom&#233;tricos y demogr&#225;ficos que se recogieron fueron&#58; sexo&#44; edad&#44; peso e &#237;ndice de masa corporal &#40;IMC&#41;&#46; El IMC se dividi&#243; en seis categor&#237;as&#58; bajo peso &#40;&#60;18&#44;5&#41;&#44; normopeso &#40;18&#44;5-24&#44;9&#41;&#44; sobrepeso &#40;25-29&#44;9&#41;&#44; obesidad de tipo I &#40;30-34&#44;9&#41;&#44; obesidad de tipo II &#40;35-39&#44;9&#41; y obesidad m&#243;rbida &#40;40-49&#44;9&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los datos cl&#237;nicos que se incluyeron fueron&#58; lugar de procedencia de los pacientes &#40;urgencias&#47;no urgencias&#41;&#44; s&#237;ntomas que presentaban &#40;fiebre&#44; tos&#44; disnea&#44; dolor tor&#225;cico&#44; s&#237;ntomas gastrointestinales&#44; s&#237;ncope y otros&#41; y fecha de inicio&#44; necesidad de ingreso en los 30 primeros d&#237;as &#40;s&#237;&#47;no&#41;&#44; n&#250;mero de d&#237;as de ingreso&#44; ingreso prolongado &#40;m&#225;s de 30 d&#237;as&#41; y fecha de entrada y salida del hospital&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Se recogieron las fechas de todas las pruebas de RT-PCR realizadas y el tiempo que transcurri&#243; desde una prueba RT-PCR positiva hasta la realizaci&#243;n de la radiograf&#237;a de t&#243;rax&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis de las im&#225;genes y obtenci&#243;n de la informaci&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">Dos residentes de radiodiagn&#243;stico de segundo y tercer a&#241;o &#40;S&#46;G&#46;P y A&#46;N&#46;M&#46;&#44; respectivamente&#41; revisaron todos los informes de las radiograf&#237;as de t&#243;rax que se encontraban en equipos con IMPAX 6&#46;5&#46;33 &#40;Agfa-Gevaert N&#46;V&#46;&#41;&#46; En el caso de que algunos estudios no tuvieran un informe radiol&#243;gico o de duda consultaron con dos radi&#243;logos tor&#225;cicos expertos con 16 y 26 a&#241;os de experiencia &#40;B&#46;C&#46;M y A&#46;B&#46;G&#46;C&#46;&#44; respectivamente&#41;&#59; las dudas se resolvieron por consenso&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0095" class="elsevierStylePara elsevierViewall">Las variables cualitativas se presentan con su distribuci&#243;n de frecuencias&#46; Las variables cuantitativas se resumen con su media y desviaci&#243;n est&#225;ndar &#40;DE&#41;&#46; Las variables cuantitativas que muestran una distribuci&#243;n asim&#233;trica se resumen con la mediana y el rango intercuart&#237;lico &#40;RIC&#41;&#46; La distribuci&#243;n de las variables continuas se evaluar&#225; mediante la inspecci&#243;n gr&#225;fica del histograma&#44; box-plot y Q-Q plots&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La variable <span class="elsevierStyleItalic">score</span> o &#237;ndice de gravedad radiogr&#225;fico se analiz&#243; como categ&#243;rica&#46; Para las variables cuantitativas se compararon las medias mediante el an&#225;lisis de la variancia &#40;ANOVA&#41; o el test de Kruskall Wallis en caso de que las variables cuantitativas no se ajustaran a una distribuci&#243;n normal&#46; Se evalu&#243; la relaci&#243;n ordinal de los par&#225;metros anal&#237;ticos y las categor&#237;as del <span class="elsevierStyleItalic">score</span> mediante el test no param&#233;trico de Jonckheere-Terpstra&#46; Las variables cualitativas se compararon mediante la prueba de la &#967;<span class="elsevierStyleSup">2</span> o test exacto de Fisher en caso de que fuera necesario&#46; Para todas las pruebas se acept&#243; un valor de significaci&#243;n del 5&#37;&#46; El procesamiento y an&#225;lisis de los datos se realiz&#243; mediante el paquete estad&#237;stico SPSS 21&#46;0&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">An&#225;lisis descriptivo</span><p id="par0105" class="elsevierStylePara elsevierViewall">Del total de 1&#46;165 pacientes consecutivos con RT-PCR para SARS-CoV-2 positiva que fueron vistos en nuestro centro entre el 29 de febrero y el 23 de marzo de 2020&#44; 761 pacientes sintom&#225;ticos adultos son los que constituyen nuestra poblaci&#243;n de estudio &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; 370 mujeres y 391 hombres con una edad media de 65&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;1 a&#241;os&#46; En cuanto al IMC&#44; hab&#237;a un 0&#44;4&#37; de pacientes con bajo peso&#44; un 14&#44;3&#37; de pacientes con valores dentro de la normalidad&#44; un 29&#44;8&#37; con sobrepeso y un 26&#44;9&#37; con obesidad&#46; En 218 &#40;28&#44;6&#37;&#41; pacientes no se dispon&#237;a de alguno de los datos necesarios para calcular el IMC &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">El 97&#44;2&#37; de los pacientes acudieron con s&#237;ntomas al servicio de urgencias&#44; 14 pacientes contrajeron la COVID-19 estando ingresados en planta y 7 lo hicieron en la unidad de cuidados intensivos&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El 74&#44;4&#37; de los 761 pacientes presentaba fiebre&#59; el 73&#44;9&#37;&#44; tos&#59; el 44&#44;7&#37;&#44; disnea&#59; el 25&#44;4&#37;&#44; s&#237;ntomas gastrointestinales&#59; el 13&#44;4&#37;&#44; dolor tor&#225;cico&#59; y el 2&#37;&#44; s&#237;ncope&#46; El tiempo transcurrido entre el comienzo de los s&#237;ntomas y la consulta m&#233;dica fue de 0-2 d&#237;as en 165 pacientes &#40;21&#44;7&#37;&#41;&#44; de 3-5 d&#237;as en 221 &#40;29&#37;&#41;&#44; de 6-9 d&#237;as en 241 pacientes &#40;31&#44;7&#37;&#41; y m&#225;s de 9 d&#237;as en 134 &#40;17&#44;6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">De los 761 pacientes&#44; 639 precisaron ingreso hospitalario &#40;84&#37;&#41; mientras que 122 fueron dados de alta para continuar aislamiento domiciliario&#46; La necesidad de ingreso fue mayor cuanto m&#225;s alto fue el &#237;ndice de gravedad radiogr&#225;fico &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">An&#225;lisis radiogr&#225;fico</span><p id="par0125" class="elsevierStylePara elsevierViewall">Se hicieron 368 radiograf&#237;as de t&#243;rax &#40;48&#44;4&#37;&#41; con el paciente en bipedestaci&#243;n &#40;proyecciones posteroanterior y lateral&#41; y 393 &#40;51&#44;6&#37;&#41; en proyecci&#243;n anteroposterior&#44; de las cuales 361 &#40;91&#44;8&#37;&#41; fueron radiograf&#237;as port&#225;tiles&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">De los 761 pacientes estudiados&#44; 295 &#40;38&#44;8&#37;&#41; presentaron una radiograf&#237;a de t&#243;rax normal al diagn&#243;stico y 466 &#40;61&#44;2&#37;&#41; ten&#237;an hallazgos patol&#243;gicos&#46; De las radiograf&#237;as patol&#243;gicas&#44; 168 &#40;36&#37;&#41; mostraban un aumento de densidad en vidrio deslustrado&#44; mientras que 202 presentaban consolidaci&#243;n pulmonar &#40;43&#44;3&#37;&#41;&#46; Vidrio deslustrado y consolidaci&#243;n pulmonar se vieron en 40 pacientes &#40;8&#44;5&#37;&#41;&#44; y una neumon&#237;a lobar en 56 &#40;12&#37;&#41; pacientes&#46; Adem&#225;s&#44; otros hallazgos menos frecuentes fueron derrame pleural en 25 casos &#40;5&#44;4&#37;&#41;&#44; fibrosis pulmonar por patolog&#237;a previa en 15 pacientes &#40;3&#44;2&#37;&#41;&#44; opacidades lineales en 9 pacientes &#40;1&#44;9&#37;&#41;&#44; enfisema pulmonar en otros 9 casos &#40;1&#44;9&#37;&#41; y n&#243;dulos o masas pulmonares en 4 casos &#40;0&#44;9&#37;&#41;&#46; En ning&#250;n caso se identificaron adenopat&#237;as &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">En cuanto a la distribuci&#243;n de los hallazgos en la radiograf&#237;a de t&#243;rax&#44; predomin&#243; la distribuci&#243;n perif&#233;rica y la afectaci&#243;n bilateral&#58; 417 casos &#40;89&#44;5&#37;&#41; mostraron una localizaci&#243;n perif&#233;rica&#44; 45 casos &#40;9&#44;7&#37;&#41; una localizaci&#243;n difusa tanto central como perif&#233;rica y 4 de 466 casos presentaron una distribuci&#243;n central &#40;0&#44;9&#37;&#41;&#46; La afectaci&#243;n unilateral se encontr&#243; en 175 &#40;37&#44;6&#37;&#41; pacientes&#44; mientras que 291 ten&#237;an afectaci&#243;n en ambos pulmones &#40;62&#44;4&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Por campos pulmonares&#44; los m&#225;s afectados fueron los medios e inferiores&#58; el campo medio derecho en un 56&#44;4&#37;&#44; el inferior derecho en un 55&#44;8&#37;&#59; el medio izquierdo en un 57&#44;5&#37; y el inferior izquierdo en un 55&#44;6&#37;&#46; La afectaci&#243;n del campo pulmonar superior derecho se encontr&#243; en un 20&#44;4&#37; de casos&#44; mientras que la del superior izquierdo en un 12&#44;2&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Cuantificaci&#243;n de la gravedad de la afectaci&#243;n pulmona<span class="elsevierStyleItalic">r</span></span><p id="par0145" class="elsevierStylePara elsevierViewall">De los 761 pacientes&#44; 295 &#40;38&#44;8&#37;&#41; no presentaban afectaci&#243;n radiogr&#225;fica inicial &#40;<span class="elsevierStyleItalic">score</span> 0&#41;&#59; 141 &#40;18&#44;5&#37;&#41; pacientes presentaron un <span class="elsevierStyleItalic">score</span> de 1&#59; 113 &#40;14&#44;8&#37;&#41; un <span class="elsevierStyleItalic">score</span> de 2 y 81 pacientes &#40;10&#44;6&#37;&#41; un <span class="elsevierStyleItalic">score</span> de 3&#46; De los 131 pacientes restantes&#44; el <span class="elsevierStyleItalic">score</span> fue 4 para 83 &#40;10&#44;9&#37;&#41; pacientes&#44; 5 para 28 &#40;3&#44;7&#37;&#41; y 6 para 20 &#40;2&#44;6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">No hubo diferencias estad&#237;sticamente significativas del &#237;ndice de gravedad radiogr&#225;fico ni por sexo ni por grupos de edad&#59; sin embargo&#44; s&#237; las hubo por valores de IMC &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; siendo mayor el IMC en pacientes con un <span class="elsevierStyleItalic">score</span> alto que en aquellos con un <span class="elsevierStyleItalic">score</span> bajo&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Se encontr&#243; una asociaci&#243;n directa estad&#237;sticamente significativa entre los d&#237;as transcurridos desde el inicio de los s&#237;ntomas y el <span class="elsevierStyleItalic">score o &#237;ndice de gravedad radiogr&#225;fico</span> &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En los pacientes con s&#237;ntomas de 0-2 d&#237;as de evoluci&#243;n no se encontraron hallazgos en un 59&#44;4&#37; de los casos&#44; porcentaje que disminuye progresivamente hasta el 24&#44;6&#37; en aquellos con s&#237;ntomas de 9 o m&#225;s d&#237;as de evoluci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">Del total de 466 radiograf&#237;as con hallazgos &#40;61&#44;2&#37;&#41;&#44; la frecuencia de vidrio deslustrado fue mayor en los &#237;ndices de gravedad radiogr&#225;ficos bajos y fue decreciendo a medida que aumentaba la puntuaci&#243;n &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; mientras que ocurri&#243; lo inverso con la consolidaci&#243;n pulmonar&#44; que fue m&#225;s frecuente a medida que aumentaba el &#237;ndice de gravedad radiogr&#225;fico &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a> y <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">La asociaci&#243;n entre los valores anal&#237;ticos obtenidos &#40;leucocitos&#44; linfocitos &#8211;valor absoluto y relativo&#8211;&#44; plaquetas&#44; PCR&#44; d&#237;mero-D&#44; LDH&#44; ferritina y CK&#41; y el &#237;ndice de gravedad radiogr&#225;fico de la afectaci&#243;n pulmonar en la radiograf&#237;a de t&#243;rax inicial fue estad&#237;sticamente significativa en todos los casos&#46; Todos los valores anal&#237;ticos aumentaron conforme el &#237;ndice radiogr&#225;fico aumentaba&#44; a excepci&#243;n de dos par&#225;metros&#44; el recuento de linfocitos y el cociente linfocitos&#47;leucocitos&#44; cuyo valor disminuy&#243; a medida que aumentaba la afectaci&#243;n radiol&#243;gica&#46; La significaci&#243;n estad&#237;stica fue <span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 para las plaquetas&#44; <span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01 para los linfocitos y <span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 para el resto de los valores &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discusi&#243;n</span><p id="par0170" class="elsevierStylePara elsevierViewall">Se encontr&#243; en nuestro estudio una relaci&#243;n estad&#237;sticamente significativa entre la extensi&#243;n de la afectaci&#243;n en la radiograf&#237;a de t&#243;rax inicial y los par&#225;metros anal&#237;ticos estudiados&#44; as&#237; como con los d&#237;as de evoluci&#243;n desde el inicio de los s&#237;ntomas&#46; La necesidad de ingreso hospitalario fue mayor cuanto m&#225;s alto fue el &#237;ndice de gravedad radiogr&#225;fico&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">La fiebre y la tos fueron las manifestaciones cl&#237;nicas encontradas m&#225;s frecuentes seguidas de la disnea&#44; los s&#237;ntomas gastrointestinales y el dolor tor&#225;cico&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">El 38&#44;8&#37; de los pacientes sintom&#225;ticos con COVID-19 de nuestro estudio present&#243; una radiograf&#237;a de t&#243;rax normal al diagn&#243;stico y un 61&#44;2&#37; ten&#237;a hallazgos patol&#243;gicos&#44; porcentaje similar al de otras series&#44; 60-91&#37;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;20&#44;21</span></a>&#46; La afectaci&#243;n pulmonar ten&#237;a un predominio bilateral&#44; en los campos inferiores y en la periferia del pulm&#243;n&#44; seg&#250;n lo descrito en la literatura m&#233;dica<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;18&#44;22</span></a>&#46; La consolidaci&#243;n fue el hallazgo m&#225;s com&#250;n seguido de las opacidades en vidrio deslustrado&#44; de acuerdo con lo publicado en otras series<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#46; El 12&#37; de nuestros pacientes presentaron una neumon&#237;a lobar&#44; hallazgo que habitualmente sugiere una etiolog&#237;a bacteriana&#44; a pesar de lo cual estos pacientes presentaron una PCR positiva y no se diagnostic&#243; una infecci&#243;n bacteriana en el momento inicial&#46; El derrame pleural fue un hallazgo infrecuente y en casi todos los casos&#44; secundario a otra patolog&#237;a &#40;antecedente de insuficiencia cardiaca&#44; derrame pleural cr&#243;nico ya existente en radiograf&#237;as de t&#243;rax previas&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Diferentes autores han propuesto sistemas de puntuaci&#243;n de los hallazgos radiol&#243;gicos tanto para la TC como para la radiograf&#237;a de t&#243;rax&#44; intentando graduar o cuantificar la extensi&#243;n de la afectaci&#243;n pulmonar en los pacientes con COVID-19 y relacionarla con la evoluci&#243;n cl&#237;nica de estos pacientes&#46; Warren et al&#46; utilizaron un &#237;ndice de gravedad del edema pulmonar &#40;RALE&#41; que fue &#250;til a la hora de cuantificar la gravedad del distr&#233;s respiratorio del adulto<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; Posteriormente&#44; otros autores han empleado una modificaci&#243;n de este sistema de puntuaci&#243;n para estimar la gravedad de la afectaci&#243;n pulmonar en pacientes con COVID-19<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14&#8211;16&#44;23&#44;24</span></a> o han creado un sistema de cuantificaci&#243;n propio como el de Borghesi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a>&#44; quienes observaron que el &#237;ndice de gravedad radiol&#243;gico era significativamente mayor &#40;<span class="elsevierStyleItalic">p</span>&#8804;0&#44;002&#41; en aquellos pacientes que fallecieron&#46; Adem&#225;s&#44; Xiao et al&#46; identificaron una asociaci&#243;n estad&#237;sticamente significativa entre el &#237;ndice de gravedad y la necesidad de intubaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Se ha descrito que aquellos pacientes con mayor edad y mayor n&#250;mero de comorbilidades presentan neumon&#237;as por SARS-CoV-2 m&#225;s graves<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a>&#46; Toussie et al&#46; observaron que los pacientes varones&#44; de mayor edad y con mayor IMC presentaban un &#237;ndice de gravedad mayor&#44; mientras que Borghesi et al&#46; observaron que el &#237;ndice de gravedad era significativamente mayor en hombres y en el grupo de edad comprendido entre los 50 y los 80 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11&#44;27</span></a>&#46; No obstante&#44; en nuestro estudio no encontramos diferencias estad&#237;sticamente significativas entre el &#237;ndice de gravedad radiogr&#225;fico y la edad o el sexo de nuestros pacientes&#44; pero s&#237; con el IMC &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Se ha encontrado en nuestro trabajo una relaci&#243;n lineal directa significativa entre la existencia de consolidaciones pulmonares en la radiograf&#237;a de t&#243;rax y un &#237;ndice de gravedad radiogr&#225;fico mayor&#44; y una relaci&#243;n lineal inversa significativa entre la frecuencia de opacidades en vidrio deslustrado e &#237;ndices de gravedad m&#225;s bajos&#46; Al igual que en el estudio de Toussie et al&#46;&#44; tambi&#233;n se observ&#243; una asociaci&#243;n directa significativa entre los d&#237;as transcurridos desde el inicio de los s&#237;ntomas y el &#237;ndice de gravedad radiogr&#225;fico&#44; empeorando la puntuaci&#243;n a medida que aumentaban los d&#237;as de evoluci&#243;n<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a>&#46; Esto es consistente con los estudios que han descrito los cambios temporales de los hallazgos pulmonares&#58; el vidrio deslustrado es el patr&#243;n predominante al inicio de los s&#237;ntomas&#44; posteriormente progresa hacia un patr&#243;n mixto de atenuaci&#243;n en vidrio deslustrado y consolidaci&#243;n pulmonar alcanzando su m&#225;xima expresi&#243;n los d&#237;as 6&#46;&#176;-13&#46;&#176;&#46; Finalmente&#44; vuelve a predominar el vidrio deslustrado hasta su resoluci&#243;n&#46; Un porcentaje de pacientes no evoluciona favorablemente y presenta signos de fibrosis pulmonar&#44; con un grado de extensi&#243;n variable<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#44;28&#44;29</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Los principales par&#225;metros anal&#237;ticos que se han relacionado con la gravedad de la neumon&#237;a COVID-19 y la evoluci&#243;n de estos pacientes son el aumento de la PCR &#40;58&#44;3-60&#44;7&#37;&#41;&#44; del d&#237;mero-D &#40;46&#44;6&#37;&#41;&#44; de la LDH &#40;41-57&#37;&#41; y la linfopenia &#40;43-83&#44;2&#37;&#41;&#46; Tambi&#233;n se ha descrito un aumento de los leucocitos&#44; las plaquetas y la CK<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12&#44;18&#44;24</span></a>&#46; De hecho&#44; Gatti et al&#46; afirman que la LDH y la PCR son los principales predictores de hallazgos en la radiograf&#237;a de t&#243;rax&#44; con una sensibilidad del 90&#37; si ambos par&#225;metros est&#225;n elevados<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a>&#46; En nuestro estudio&#44; los pacientes con enfermedad m&#225;s grave ten&#237;an alteraciones anal&#237;ticas m&#225;s acusadas que aquellos con enfermedad menos grave&#44; observ&#225;ndose una asociaci&#243;n significativa entre los valores anal&#237;ticos obtenidos y el &#237;ndice de gravedad radiogr&#225;fico&#46; Todos los valores anal&#237;ticos aumentaron conforme el <span class="elsevierStyleItalic">score</span> aumentaba&#44; a excepci&#243;n de dos par&#225;metros&#44; el recuento de linfocitos y el cociente linfocitos&#47;leucocitos&#44; cuyo valor disminuy&#243; a medida que aumentaba la afectaci&#243;n radiol&#243;gica&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene algunas limitaciones&#46; En primer lugar&#44; al ser un estudio retrospectivo y centrado en la primera &#233;poca de la pandemia&#44; no dispon&#237;amos de protocolos consolidados de informes radiol&#243;gicos en pacientes con COVID-19 y tampoco se sab&#237;a con certeza qu&#233; par&#225;metros eran m&#225;s &#250;tiles en la anal&#237;tica de sangre&#44; por lo que existe un n&#250;mero importante de datos perdidos que han reducido la muestra final&#46; No obstante&#44; el tiempo transcurrido entre la realizaci&#243;n de la radiograf&#237;a de t&#243;rax y el an&#225;lisis de sangre al diagn&#243;stico fue siempre inferior a 24 horas&#46; En segundo lugar&#44; nuestro estudio presenta las limitaciones inherentes a la t&#233;cnica radiol&#243;gica empleada en la ejecuci&#243;n y la interpretaci&#243;n&#44; en muchas ocasiones magnificadas por la situaci&#243;n cl&#237;nica de estos enfermos&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; la radiograf&#237;a de t&#243;rax es una t&#233;cnica v&#225;lida en la valoraci&#243;n inicial de pacientes con COVID-19&#44; cuyos hallazgos deber&#237;an considerarse junto con los datos anal&#237;ticos y cl&#237;nicos a la hora de evaluar la evoluci&#243;n de estos pacientes&#44; pues a mayor &#237;ndice de gravedad radiogr&#225;fico&#44; mayor incidencia de ingreso hospitalario y par&#225;metros anal&#237;ticos m&#225;s alterados&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Autor&#237;a</span><p id="par0215" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Responsable de la integridad del estudio&#58; AB&#44; BC&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0225" class="elsevierStylePara elsevierViewall">Concepci&#243;n del estudio&#58; AB&#44; BC&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Dise&#241;o del estudio&#58; AB&#44; &#193;NM&#44; SGP&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0235" class="elsevierStylePara elsevierViewall">Obtenci&#243;n de los datos&#58; &#193;NM&#44; SGP&#44; AV&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0240" class="elsevierStylePara elsevierViewall">An&#225;lisis e interpretaci&#243;n de los datos&#58; MEFF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Tratamiento estad&#237;stico&#58; MEFF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0250" class="elsevierStylePara elsevierViewall">B&#250;squeda bibliogr&#225;fica&#58; AB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Redacci&#243;n del trabajo&#58; &#193;NM&#44; SGP&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Revisi&#243;n cr&#237;tica del manuscrito con aportaciones intelectualmente relevantes&#58; AB&#44; BC&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Aprobaci&#243;n de la versi&#243;n final&#58; AB&#44; BC&#46;</p></li></ul></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0270" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar los hallazgos radiol&#243;gicos iniciales en las radiograf&#237;as de t&#243;rax de pacientes con RT-PCR positiva para SARS-CoV-2 y valorar si existe una relaci&#243;n entre la graduaci&#243;n de los mismos y los datos cl&#237;nicos y anal&#237;ticos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo donde se analizaron las radiograf&#237;as de t&#243;rax iniciales de pacientes adultos sintom&#225;ticos entre el 29 de febrero y el 23 de marzo de 2020 con una prueba RT-PCR nasofar&#237;ngea positiva para SARS-CoV-2 y una anal&#237;tica inicial que inclu&#237;a&#58; leucocitos&#44; linfocitos&#44; plaquetas&#44; cociente linfocitos&#47;leucocitos y PCR&#46; Entre otros hallazgos radiol&#243;gicos se valoraron&#58; opacidades en vidrio deslustrado&#44; consolidaciones&#44; opacidades lineales y derrame pleural&#46; Tambi&#233;n la distribuci&#243;n y la extensi&#243;n de estos hallazgos mediante un &#237;ndice de gravedad radiogr&#225;fico&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De 761&#160;pacientes sintom&#225;ticos&#44; 639 precisaron ingreso hospitalario &#40;84&#37;&#41; y 122 fueron dados de alta con aislamiento domiciliario&#46; La necesidad de ingreso fue mayor cuanto m&#225;s alto el &#237;ndice de gravedad radiogr&#225;fico&#46; Existi&#243; una relaci&#243;n estad&#237;sticamente significativa entre la extensi&#243;n de la afectaci&#243;n pulmonar inicial y los par&#225;metros anal&#237;ticos estudiados &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 para plaquetas&#44; <span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01 para linfocitos y <span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 para el resto&#41;&#44; as&#237; como con los d&#237;as de evoluci&#243;n desde el inicio de los s&#237;ntomas &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La graduaci&#243;n de los hallazgos radiol&#243;gicos al diagn&#243;stico y su relaci&#243;n con los datos anal&#237;ticos podr&#237;a ser &#250;til a la hora de valorar la evoluci&#243;n de pacientes con COVID-19&#44; pues a mayor &#237;ndice de gravedad radiogr&#225;fico&#44; mayor incidencia de ingreso hospitalario y par&#225;metros anal&#237;ticos m&#225;s alterados&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusi&#243;n"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2&#44; and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23&#44; 2020&#46; Among other radiologic findings&#44; we analyzed ground-glass opacities&#44; consolidations&#44; linear opacities&#44; and pleural effusion&#46; We also used a scale of radiologic severity to assess the distribution and extent of these findings&#46; Among initial laboratory findings&#44; we analyzed leukocytes&#44; lymphocytes&#44; platelets&#44; neutrophil-to-lymphocyte ratio&#44; and C-reactive protein&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of 761 symptomatic patients&#44; 639 &#40;84&#37;&#41; required hospitalization and 122 were discharged to their homes&#46; The need for admission increased with increasing scores on the scale of radiologic severity&#46; The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 for platelets&#44; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01 for lymphocytes&#44; and p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for the remaining parameters&#41;&#44; as well as with the time from the onset of symptoms &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19&#44; because the greater the radiologic severity&#44; the greater the need for hospitalization and the greater the alteration in laboratory parameters&#46;</p></span>"
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            "titulo" => "Results"
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            "identificador" => "abst0040"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">De los 1&#46;165 pacientes iniciales fueron excluidos 4 pacientes menores de 18 a&#241;os&#46; Adem&#225;s&#44; se descartaron 165 pacientes por no tener una radiograf&#237;a de t&#243;rax al inicio de la enfermedad y 116 pacientes por no poseer una anal&#237;tica de sangre inicial&#46; Por &#250;ltimo&#44; de los 880 pacientes restantes&#44; 119 no presentaban las detecciones anal&#237;ticas en sangre de los 5 par&#225;metros necesarios para la inclusi&#243;n en este estudio&#58; recuento de leucocitos&#44; de linfocitos&#44; de plaquetas&#44; cociente linfocitos&#47;leucocitos y PCR&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Radiograf&#237;a de t&#243;rax con la divisi&#243;n pulmonar en seis campos que se ha empleado en nuestro estudio para la valoraci&#243;n de la distribuci&#243;n de los hallazgos radiol&#243;gicos&#46; La l&#237;nea horizontal superior pasa por el borde inferior del arco a&#243;rtico y la l&#237;nea horizontal inferior pasa a la altura de las venas pulmonares inferiores&#46; A y B&#41; Campos superiores&#46; C y D&#41; Campos medios&#46; E y F&#41; Campos inferiores&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Relaci&#243;n porcentual entre los d&#237;as transcurridos desde el inicio de los s&#237;ntomas y el &#237;ndice de gravedad radiogr&#225;fico&#46; En el eje <span class="elsevierStyleItalic">x</span> est&#225;n representados cada uno de los &#237;ndices de gravedad radiol&#243;gicos &#40;se combinaron los &#237;ndices de gravedad 5 y 6 por el escaso n&#250;mero de pacientes&#41;&#46; En el eje <span class="elsevierStyleItalic">y</span> est&#225; representado el porcentaje de pacientes con un determinado tiempo de evoluci&#243;n de los s&#237;ntomas dentro de cada &#237;ndice de gravedad&#46;</p>"
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        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A y B&#41; Var&#243;n de 49 a&#241;os&#44; exfumador desde hace 5 a&#241;os&#44; con antecedentes de hipertensi&#243;n arterial&#44; dislipemia&#44; cardiopat&#237;a hipertensiva&#44; hiperuricemia&#44; trasplante renal y tiroidectom&#237;a total por carcinoma papilar de tiroides&#46; Acude por fiebre&#44; tos seca y mialgias de 4 d&#237;as de evoluci&#243;n&#46; Datos de laboratorio&#58; leucocitos 7&#46;100&#47;&#956;L&#44; linfocitos 600&#47;&#956;L &#40;linfocitos&#47;leucocitos 7&#44;7&#37;&#41;&#44; plaquetas 140&#46;000&#47;&#956;L&#44; PCR 1&#44;63<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; d&#237;mero D 754 ng&#47;mL y LDH 471 U&#47;L&#46; Radiograf&#237;a de t&#243;rax posteroanterior del 16 de marzo de 2020 donde se observa una opacidad en vidrio deslustrado&#44; perif&#233;rica&#44; en el campo medio derecho &#40;<span class="elsevierStyleItalic">score</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;flecha&#41;&#46; El paciente ingres&#243; y en la radiograf&#237;a de t&#243;rax del d&#237;a 24 de marzo de 2020 se ve un claro empeoramiento radiol&#243;gico con consolidaciones pulmonares bilaterales&#44; m&#225;s extensas &#40;flechas&#41;&#44; asociado a un incremento de las necesidades de oxigenoterapia&#46; <span class="elsevierStyleBold">C y D&#41;</span> Mujer de 33 a&#241;os&#44; procedente de Guatemala&#44; sin antecedentes personales de inter&#233;s&#44; que acude al servicio de urgencias derivada por su m&#233;dico de atenci&#243;n primaria por tos y fiebre de 9 d&#237;as de evoluci&#243;n&#46; Anal&#237;tica sangu&#237;nea&#58; leucocitos 5&#46;100&#47;&#956;L&#44; linfocitos 1&#46;400&#47;&#956;L &#40;linfocitos&#47;leucocitos 27&#44;9&#37;&#41;&#44; plaquetas 224&#46;000&#47;&#956;L&#44; PCR 8&#44;44<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; d&#237;mero D 500 ng&#47;mL y LDH 666 U&#47;L&#46; En la radiograf&#237;a de t&#243;rax posteroanterior del 17 de marzo de 2020 se identifican consolidaciones pulmonares bilaterales&#44; parcheadas y de predominio en los l&#243;bulos inferiores &#40;score<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; &#40;flechas&#41;&#46; La paciente ingres&#243; y 2 d&#237;as despu&#233;s present&#243; empeoramiento cl&#237;nico y anal&#237;tico&#44; observ&#225;ndose en la radiograf&#237;a del d&#237;a 23 de marzo un empeoramiento radiol&#243;gico&#44; con confluencia de las consolidaciones previas&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Caracter&#237;sticas cl&#237;nicas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">n 761 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Edad &#40;a&#241;os&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22 &#40;2&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>31-40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45 &#40;5&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>41-50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">93 &#40;12&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>51-60&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>61-70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>71-80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>81-90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">149 &#40;19&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>91-100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">IMC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Bajo peso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;0&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Normopeso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">109 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">227 &#40;29&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fiebre&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">566 &#40;74&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Disnea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor tor&#225;cico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ncope&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0-2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3-5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6-9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hallazgos en la radiograf&#237;a de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>761 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Radiograf&#237;a de t&#243;rax normal</span><span class="elsevierStyleItalic">Radiograf&#237;a de t&#243;rax patol&#243;gica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">295 &#40;38&#44;8&#37;&#41;466 &#40;61&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vidrio deslustrado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">168 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consolidaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">202 &#40;43&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consolidaci&#243;n y vidrio deslustrado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;8&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a lobar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Derrame pleural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;5&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrosis pulmonar previa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;3&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Opacidades lineales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfisema pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>N&#243;dulo&#47;masa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">4 &#40;0&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adenopat&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3232573.png"
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            1 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Distribuci&#243;n por campos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>466 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Derecho</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;12&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;20&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">259 &#40;57&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263 &#40;56&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">259 &#40;55&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">260 &#40;55&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Afectaci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>466 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Afectaci&#243;n unilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">175 &#40;37&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Afectaci&#243;n bilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">291 &#40;62&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Distribuci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>466 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Distribuci&#243;n perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">417 &#40;89&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Distribuci&#243;n central&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Distribuci&#243;n difusa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;9&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de gravedad radiogr&#225;fico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Incidencia de vidrio deslustrado y consolidaci&#243;n pulmonar seg&#250;n el &#237;ndice de gravedad radiogr&#225;fico</p>"
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        "etiqueta" => "Tabla 5"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Debido al escaso n&#250;mero de pacientes con un &#237;ndice de gravedad elevado&#44; se decidi&#243; combinar en una misma categor&#237;a los &#237;ndices de gravedad de 5 y 6&#46;</p>"
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Información del artículo
ISSN: 00338338
Idioma original: Español
DOI:10.1016/j.rx.2021.06.001
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2022 Agosto 49 0 49
2022 Julio 84 4 88
2022 Junio 82 3 85
2022 Mayo 98 2 100
2022 Abril 59 8 67
2022 Marzo 81 10 91
2022 Febrero 114 13 127
2022 Enero 228 35 263
2021 Diciembre 125 40 165
2021 Noviembre 74 43 117
2021 Octubre 0 6 6
2021 Septiembre 0 8 8
2021 Agosto 0 2 2
2021 Julio 0 19 19
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