title: Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia?
abstract: 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.
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh, PA, USA.
authors.forename: P B
authors.initials: PB
authors.lastname: Hasley
authors.forename: M N
authors.initials: MN
authors.lastname: Albaum
authors.forename: Y H
authors.initials: YH
authors.lastname: Li
authors.forename: C R
authors.initials: CR
authors.lastname: Fuhrman
authors.forename: C A
authors.initials: CA
authors.lastname: Britton
authors.forename: T J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: D E
authors.initials: DE
authors.lastname: Singer
authors.forename: C M
authors.initials: CM
authors.lastname: Coley
authors.forename: W N
authors.initials: WN
authors.lastname: Kapoor
authors.forename: M J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections; D015897:Comorbidity; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015999:Multivariate Analysis; D010996:Pleural Effusion / Q000150:complications; D011014:Pneumonia / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011859:Radiography; D015996:Survival Rate