DO PULMONARY RADIOGRAPHIC FINDINGS AT PRESENTATION PREDICT MORTALITY IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

Background: Previous studies have reported conflicting results on whet her pulmonary radiographic findings predict mortality for patients wit h community-acquired pneumonia (CAP). Objective: To determine whether pulmonary radiographic findings at presentation are independently asso ciated with 30-day mortality in patients with suspected CAP. Methods: This study was conducted as part of the Pneumonia Patient Outcomes Res earch Team multicenter, prospective cohort study of ambulatory and hos pitalized patients with clinical and radiographic evidence of CAP. For each patient with CAP, a structured data form was completed by a pane l of radiologists to evaluate the radiographic pattern of infiltrate, number of lobes involved, presence of pleural effusion, and 8 other ra diographic characteristics. Cox proportional hazards models were used to evaluate the independent association between radiographic findings and 30-day mortality, while controlling for patient demographic, clini cal, 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 pulmo nary radiographic infiltrate confirmed by the radiology panel. Overall , 30-day mortality in this cohort was 4.9%. Univariate regression anal yses demonstrated the following radiographic characteristics to be sig nificantly associated with 30-day mortality: (1) bilateral pleural eff usions (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% C I, 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 feat ures and other clinical characteristics showed the presence of bilater al pleural effusions (RR, 2.8; 95% CI, 1.4-5.8) was independently asso ciated with mortality. Conclusions: In patients with CAP, the presence of bilateral pleural effusions is an independent predictor of short-t erm mortality. This finding, which is available at presentation, can h elp guide physicians' assessment of prognosis in CAP.