Do Pulmonary Radiographic Findings at Presentation Predict Mortality in Patients With Community-Acquired Pneumonia?

Abstract

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.

The risk factors for mortality of community-acquired pneumonia in Japan

“…In our study, the extent of chest radiogram fi ndings had a strong positive correlation with CAP mortality, confi rming the previous studies in Western countries. 10,24,[26][27][28][29] When we evaluated the chest radiogram fi ndings as recommended by the Japanese Respiratory Society (JRS) guidelines, 7 the severe infi ltration which corresponds to a pneumonia score of 7 or higher was not associated with CAP mortality according to statistical analysis. However, the frequency of patients with moderate or severe infi ltration (pneumonia score ≥6) in the fatal group was significantly greater than that in the survival group, and a high pneumonia score (>6) was found to be an independent risk factor for mortality.…”

“…The fi ndings, including location of infi ltration, sphere of infi ltration, pneumonia score, and the presence of pleural effusion on chest radiograms, were reviewed and diagnosed by two respirologists and a radiologist. 9,10,13 The pneumonia score was defi ned on the basis of the area of involvement on chest radiograph fi ndings: score 1, very small infi ltrate limited to one intercostal site; score 2, between scores 1 and 3; score 3, infi ltrate involving 1/10 of a lung; score 4, between scores 3 and 5; score 5, infi ltrate involving 1/3 of a lung; score 6, between scores 5 and 7; score 7, infi ltrate involving 2/3 of a lung; score 8, infi ltrate involving almost one entire lung; score 9, between scores 8 and 10; score 10, infi ltrate involving almost all of both lungs completely. 14 …”

“…[4][5][6][7][8] In addition, prediction rules to assess the patients' risk have been developed by several study groups. 9,10 It is suggested, but not proven, that these clinical guidelines and prediction rules improve the quality of care of patients with CAP. However, a lack of suffi cient evidence has led to different recommendations over some issues, and these discrepancies sometimes cause confusion among physicians.…”

Management of parapneumonic effusion and pleural empyema

“…Auf der Basis aktueller Angaben zur Prävalenz der Pneumonie (http://www.BQS-online.de) muss daher von einer jährlichen Anzahl von mindestens 50.000 Fällen in Deutschland ausgegangen werden. Morbidität und Letalität der Pneumonie werden durch das Auftreten eines parapneumonischen Ergusses erhöht [2,3]. Das Pleuraempyem tritt in der Mehrzahl der Fälle (ca.…”

Complicated parapneumonic effusion and empyema: Pleural decortication and video-assisted thoracic surgery

“…However, 10% to 20% of patients develop a complicated parapneumonic effusion or pleural empyema, in which the fluid becomes more exudative and which usually requires more aggressive therapy [3]. Progression to empyema is related to delay in appropriate management (eg, antibiotic therapy or drainage procedure) and usually results in higher mortality (3.7 and 7.5 times higher for unilateral and bilateral effusions, respectively) [4][5][6]. In addition to pulmonary infection, empyema can also develop after thoracic surgery or invasive procedure, trauma, esophageal perforation, systemic infection, or transdiaphragmatic spread [7,8].…”