Independent radiographic prognostic factors in patients with hospital-treated community-aquired pneumonia.

Purpose: To evaluate the independent prognostic impact of the chest radiogr aph for mortality from community-acquired pneumonia requiring hospitalizati on. Methods: Chest radiographs of 67 patients with hospital-treated communi ty-acquired pneumonia were analyzed with regard to the prognostic implicati ons of radiographic patterns, extent and density of infiltrates, and its ev olution during treatment. Results: Nonsurvivors had a significantly higher extent of infiltrates (p = 0.008), density of infiltrates (p = 0.05), and r adiographic spread during follow-up within 48-72 hours (p = 0.0001). In mul tivariate analysis, persistent or progressive infiltrates were associated w ith a 47fold increase, and persistent or progressive density of infiltrates with an 18fold increase in risk of mortality. The presence of both paramet ers could correctly predict 96% of survivors and 90% of non-survivors. Conc lusions: The chest radiograph is an independent predictor of the severity o f pneumonia. Both persistent or progressive infiltrates and persistent or p rogressive density of infiltrates are independently associated with mortali ty from community-acquired pneumonia.