Chest imaging of COVID-19 patients amongst diverse vaccination status: A comparative study using Brixia Score

Background: Covid-19 vaccination has reached more than 132 million people in Indonesia since its first outbreak in March 2020. However; its effects on immunity are still lack of evidence. Covid-19 cases reached a significant increase in June 2021 and decreased in November 2021. In early 2022; it again recorded an increase. Seeing this phenomenon; this study investigates the differences of Covid-19 Patients’ severity levels over their vaccination status.

Objective: This study examines the differences of severity level of chest x-ray imaging in covid-19 patients treated at Dr. Moewardi Hospital in three periods of time.

Methods: A total of 89 covid-19 cases were collected from 3 different vaccination status: (1) 30 non-vaccinated patients (group A); (2) 30 patients treated for covid-19 after 1-3 months post-vaccination (group B); (3) 29 treated for covid-19 after more than 6 months post-vaccination (group C). Patients with type-II diabetes mellitus; heart failure or autoimmune disease were excluded. Severity level is based on chest x-ray examination by calculating the Brixia score by 3 examiners. All assessment results were analysed using the Kruskall-Wallis test followed by the Mann-Whitney post-hoc test.

Results: A total of 8 male (26.7%) and 22 female (73.3%) patients in group B had lower Brixia scores with mean score 2.94 + 0.25 compared to 29 patients (55% male and 45% female) in group C with mean score 4.90 + 0.27 with a significant difference (p = 0.001). The Brixia score with the highest average was found in group A (non-vaccinated) with mean value 5.77 + 0.31 showing a significant difference from groups B and C (p<0.05).

Conclusion: Vaccine administration status showed different Brixia scores; whereas longer duration from vaccination showed higher score. Unvaccinated patients recorded the most severe condition. Booster vaccination is strongly recommended to obtain the best immunity level.