TY - JOUR T1 - Prognostic value of chest computed tomography in community-acquired pneumonia patients JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00079-2020 VL - 6 IS - 4 SP - 00079-2020 AU - Masahiro Nemoto AU - Kei Nakashima AU - Satoshi Noma AU - Yuya Matsue AU - Kazuki Yoshida AU - Hiroki Matsui AU - Atsushi Shiraishi AU - Tomoko Ishifuji AU - Konosuke Morimoto AU - Koya Ariyoshi AU - Masahiro Aoshima Y1 - 2020/10/01 UR - http://openres.ersjournals.com/content/6/4/00079-2020.abstract N2 - 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.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 ER -