Severe acute respiratory syndrome: prognostic implications of chest radiographic findings in 52 patients.
OBJECTIVE
To retrospectively assess prognostic implications of radiographic findings in severe acute respiratory syndrome (SARS).


METHODS
Radiographic findings were reviewed by two radiologists for 52 patients with SARS. On each radiograph, each lung was separated into upper, middle, and lower zones. A four-point scale was used to score extent of SARS-related lesions in each zone; points from all zones were added for a cumulative score. Patient sex, age, comorbidities, duration of developing lesions, lesion score for each radiograph, need for mechanical ventilation, and percentage of lung affected were compared between patients who died (n = 20) and survivors (n = 32). Continuous and categorical variables were analyzed with Mann-Whitney test and Fisher exact or chi(2) test, respectively.


RESULTS
Survival and mortality groups showed no significant differences with respect to patient sex, duration of SARS-related lesions, development of lesion shifting, and acute respiratory distress syndrome. Patients who died were significantly older (mean +/- standard deviation, 56.9 years +/- 17.2 vs 40.4 years +/- 16.6; P =.002) and had higher frequency of comorbid lung illnesses (nine of 20 vs two of 32, P =.001), maximal lesion extent score of 7 or higher (20 of 20 vs five of 32, P <.001), involvement of four or more lung zones (17 of 20 vs four of 32, P <.001), bilateral lung involvement (19 of 20 vs 14 of 32, P <.001), need for mechanical ventilation (18 of 20 vs two of 32, P <.001), and higher percentage of affected areas (41.5% +/- 8.6 vs 16.4% +/- 10.0, P <.001) than those of survivors.


CONCLUSIONS
On chest radiographs, maximal SARS-related lesion extent score of 7 or higher is a strong predictor of mortality, especially in patients with comorbid lung illnesses and involvement of four or more lung zones.
Department of Radiology, Chang Gung University, Chang Gung Memorial Hospital at Kaouhsiung, 123 Ta-Pei Rd, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan. sfatko@adm.cgmh.org.tw
Sheung-Fat
SF
Ko
Tze-Yu
TY
Lee
Chung-Cheng
CC
Huang
Yu-Fan
YF
Cheng
Shu-Hang
SH
Ng
Yeh-Lin
YL
Kuo
Meng-Chih
MC
Lin
Jien-Wei
JW
Liu
Kuender D
KD
Yang
Min-Chi
MC
Chen
Chao-Long
CL
Chen
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011859:Radiography; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors