Abstract
Background Chest computed tomography (CT) is commonly used to diagnose pneumonia in Japan, but its usability in terms of prognostic predictability is not obvious. We modified CURB-65 (confusion, urea >7 mmol·L−1, respiratory rate ≥30 breaths·min−1, blood pressure <90 mmHg (systolic) ≤60 mmHg (diastolic), age ≥65 years) and A-DROP scores with CT information and evaluated their ability to predict mortality in community-acquired pneumonia patients.
Methods This study was conducted using a prospective registry of the Adult Pneumonia Study Group – Japan. Of the 791 registry patients, 265 hospitalised patients with chest CT were evaluated. Chest CT-modified CURB-65 scores were developed with the first 30 study patients. The 30-day mortality predictability of CT-modified, chest radiography-modified and original CURB-65 scores were validated.
Results In score development, infiltrates over four lobes and pleural effusion on CT added extra points to CURB-65 scores. The area under the curve for CT-modified CURB-65 scores was significantly higher than that of chest radiography-modified or original CURB-65 scores (both p<0.001). The optimal cut-off CT-modified CURB-65 score was ≥4 (positive-predictive value 80.8%; negative-predictive value 78.6%, for 30-day mortality). For sensitivity analyses, chest CT-modified A-DROP scores also demonstrated better prognostic value than did chest radiography-modified and original A-DROP scores. Poor physical status, chronic heart failure and multiple infiltration hampered chest radiography evaluation.
Conclusion Chest CT modification of CURB-65 or A-DROP scores improved the prognostic predictability relative to the unmodified scores. In particular, in patients with poor physical status or chronic heart failure, CT findings have a significant advantage. Therefore, CT can be used to enhance prognosis prediction.
Abstract
Chest CT modification of CURB-65 and A-DROP improves prognosis prediction in community-acquired pneumonia. Patients with low physical status or chronic heart failure may have mismatch of chest CT and radiography findings. https://bit.ly/30GbNZS
Footnotes
This article has supplementary material available from openres.ersjournals.com
Author Contributions: M. Nemoto, K. Nakashima, Y. Matsue, K. Yoshida, Y. Matsui, and M. Aoshima contributed to the study's conception and design. K. Nakashima and M. Aoshima provided administrative support. All authors were involved in provision of study materials or patients. K. Nakashima and M. Nemoto were involved in collection and assembly of data. All authors were involved in data analysis and interpretation. All authors were involved in manuscript writing. All authors read and approved the final version of the manuscript.
Conflict of interest: M. Nemoto has nothing to disclose.
Conflict of interest: K. Nakashima has nothing to disclose.
Conflict of interest: S. Noma has nothing to disclose.
Conflict of interest: Y. Matsue has nothing to disclose.
Conflict of interest: K. Yoshida has nothing to disclose.
Conflict of interest: H. Matsui has nothing to disclose.
Conflict of interest: A. Shiraishi has nothing to disclose.
Conflict of interest: T. Ishifuji has nothing to disclose.
Conflict of interest: K. Morimoto reports grants and personal fees from Pfizer, and personal fees from MSD Pharma, outside the submitted work.
Conflict of interest: K. Ariyoshi has nothing to disclose.
Conflict of interest: M. Aoshima has nothing to disclose.
- Received February 19, 2020.
- Accepted July 19, 2020.
- Copyright ©ERS 2020
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.