Outcomes of hospitalized patients with COVID-19 pneumonia, hypoxia, and a normal initial chest roentgenogram

Background: Outcomes of patients with coronavirus disease (COVID-19) pneumonia, hypoxia, and an initial normal chest roentgenogram (CXR) are not well defined. This study aimed to analyze the factors associated with poor outcomes in these patients. Methods: This retrospective study evaluated patients admitted with COVID-19 pneumonia, a CXR without infiltrates and hypoxemia requiring supplemental oxygen. Outcomes were compared based on D-dimer levels and included in-hospital mortality, need for mechanical ventilation, acute kidney injury, shock, and length of hospital stay. Results: We identified 115 patients, 31 (27%) had D-dimer levels above 4 times upper limit of normal on admission. Predictors of mortality included elevated D-dimers in hypoxic patients, use of mechanical ventilation, acute kidney injury, shock, and elevated admission serum sodium and lactic dehydrogenase Conclusions: Patients with COVID-19 and hypoxia on initial presentation despite a normal CXR had significant mortality rates, higher in those with elevated inflammatory markers. The use of inflammatory markers, such as D-dimer and serum ferritin levels, may assist in identifying patients with higher morbidity and mortality risks. Additional imaging with chest computed tomogram should be obtained if clinically indicated and avoidance of overreliance of a normal CXR in those patients.