Value of initial chest radiographs for predicting clinical outcomes in patients with severe acute respiratory syndrome.
OBJECTIVE
To determine whether the initial chest radiograph is helpful in predicting the clinical outcome of patients with severe acute respiratory syndrome (SARS).


METHODS
Of 343 patients who met the World Health Organization's case definition of probable SARS and who had been admitted to a regional hospital in Hong Kong, 201 patients had laboratory evidence of SARS coronavirus infection. The initial frontal chest radiographs of these 201 patients were assessed in a blinded fashion by 3 radiologists; individual findings were accepted if at least 2 of the radiologists concurred. Independent predictors of an adverse outcome, defined as the need for assisted ventilation, death, or both, were identified by multivariate analysis.


RESULTS
Bilateral disease and involvement of more than two zones on the initial chest radiograph were associated with a higher risk of liver impairment and poor clinical outcome. Forty-two patients (21%) developed an adverse outcome. Multivariate analysis showed that lung involvement of more than two zones (odds ratio [OR] = 7.0; 95% confidence interval [CI]: 2.7 to 17.9), older age (OR for each decade of life = 1.5; 95% CI: 1.1 to 2.0), and shortness of breath on admission (OR = 2.8; 95% CI: 1.1 to 7.4) were independent predictors of an adverse outcome.


CONCLUSIONS
Frontal chest radiographs on presentation may have prognostic value in patients with SARS.
Chau
Tai-Nin
TN
Department of Medicine and Geriatrics, Princess Margaret Hospital, Lai Chi Kok, Hong Kong Special Administrative Region. chautainin@hotmail.com
Lee
Po-Oi
PO
Choi
Kin-Wing
KW
Lee
Chiu-Man
CM
Ma
Ka-Fai
KF
Tsang
Tak-Yin
TY
Tso
Yuk-Keung
YK
Chiu
Ming-Chee
MC
Tong
Wing-Lok
WL
Yu
Wai-Cho
WC
Lai
Sik-To
ST
D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D010343:Patient Admission; D011237:Predictive Value of Tests; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D013902:Radiography, Thoracic / Q000592:standards*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D045473:Severe acute respiratory syndrome-related coronavirus; D012698:Serologic Tests; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers; D000410:Alanine Transaminase