October 28, 1996

Do Pulmonary Radiographic Findings at Presentation Predict Mortality in Patients With Community-Acquired Pneumonia?

Author Affiliations

From the Division of General Internal Medicine (Drs Hasley, Albaum, Kapoor, and Fine), Department of Biostatistics (Dr Li), and Department of Radiology (Drs Fuhrman and Britton), University of Pittsburgh, Pittsburgh, Pa; Departments of Medicine and Microbiology, Victoria General Hospital and Dalhousie University, Halifax, Nova Scotia (Dr Marrie); General Internal Medicine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Singer and Coley).

Arch Intern Med. 1996;156(19):2206-2212. doi:10.1001/archinte.1996.00440180068008

Background:  Previous studies have reported conflicting results on whether pulmonary radiographic findings predict mortality for patients with community-acquired pneumonia (CAP).

Objective:  To determine whether pulmonary radiographic findings at presentation are independently associated with 30-day mortality in patients with suspected CAP.

Methods:  This study was conducted as part of the Pneumonia Patient Outcomes Research Team multicenter, prospective cohort study of ambulatory and hospitalized patients with clinical and radiographic evidence of CAP. For each patient with CAP, a structured data form was completed by a panel of radiologists to evaluate the radiographic pattern of infiltrate, number of lobes involved, presence of pleural effusion, and 8 other radiographic characteristics. Cox proportional hazards models were used to evaluate the independent association between radiographic findings and 30-day mortality, while controlling for patient demographic, clinical, and laboratory characteristics with a known association with this outcome.

Results:  Of 2287 patients enrolled in the Pneumonia Patient Outcomes Research Team cohort study, 1906 patients (83.3%) had a pulmonary radiographic infiltrate confirmed by the radiology panel. Overall, 30-day mortality in this cohort was 4.9%. Univariate regression analyses demonstrated the following radiographic characteristics to be significantly associated with 30-day mortality: (1) bilateral pleural effusions (risk ratio [RR], 7.0; 95% confidence interval [CI], 3.9-12.6); (2) a pleural effusion of moderate or greater size (RR, 3.4; 95% CI, 1.4-8.4); (3) 2 or more lobes involved with infiltrate (RR, 2.5; 95% CI, 1.6-3.8); (4) bilateral infiltrate (RR, 2.8; 95% CI, 1.9-4.2); (5) bronchopneumonia (RR, 1.6; 95% CI, 1.0-2.7); and (6) air bronchograms (RR, 0.5; 95% CI, 0.2-0.9). Multivariate analysis of radiographic features and other clinical characteristics showed the presence of bilateral pleural effusions (RR, 2.8; 95% CI, 1.4-5.8) was independently associated with mortality.

Conclusions:  In patients with CAP, the presence of bilateral pleural effusions is an independent predictor of short-term mortality. This finding, which is available at presentation, can help guide physicians' assessment of prognosis in CAP.Arch Intern Med. 1996;156:2206-2212