Background: Chest x-ray is one of the parameters to estimate the severity and prognosis of COVID-19. Arterial oxygen saturation (SaO2), partial pressure of arterial oxygen (PaO2), and respiratory index (PaO2/FiO2) can also predict the disease severity. Other parameters like inflammation markers also have been used as predictors for prognosis. Based on those considerations, this study will examine their connection and find their correlation. Methods: This is an analytic observational retrospective study design. The samples were moderate-critical COVID-19 patients in Ulin General Hospital Banjarmasin from July - December 2021 who met the inclusion and exclusion criteria. Statistical tests were used to see the relationship between clinical characteristics and inflammation markers with chest X-ray, using various scoring systems (Brixia, sRALE, and modified Soetomo score). Results: Total subjects were 67 patients. The data analysis found that the severity of the disease had a significant relationship with the severity of the chest X-ray (sig. < 0.001). The PF ratio also had a significant negative correlation (sig. < 0.001) with the severity of the chest x-ray. For inflammation markers, NLR, CRP, and LDH significantly correlated with a chest x-ray. The patient's outcome is also associated with a chest X-ray (sig. < 0.015). Conclusion: There were significant correlations between clinical characteristics and inflammation markers on the chest X-ray severity, and sRALE was a better scoring system to assess chest x-ray severity than other scoring systems. Keywords: COVID-19, disease severity, inflammation markers, PF ratio, chest X-ray
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