Chest Radiograph Scores as Potential Prognostic Indicators in Severe Acute Respiratory Syndrome (SARS)
- 1 March 2005
- journal article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 184 (3), 734-741
- https://doi.org/10.2214/ajr.184.3.01840734
Abstract
OBJECTIVE. We analyzed serial chest radiographic scores for lung opacification in patients with severe acute respiratory syndrome (SARS) for temporal changes and differences between fatal and discharged cases. We sought to establish the earliest radiographic scores sensitive as potential prognostic indicators of fatal outcomes. MATERIALS AND METHODS. Chest radiographs that had been obtained from presentation until the death or discharge of 313 patients with SARS were scored on the basis of the percentage area and location of lung opacification. Profile analysis and univariable logistic regression were performed on these radiographic scores. RESULTS. Despite the increased mortality risks of advanced age and male sex, no significant difference was seen in the percentage area of opacification (AO%) between the sexes in either the group of patients with fatal outcomes or the group of patients who were discharged. No difference existed between age groups (< 65 years vs ≥ 65 years), except for the radiograph showing the peak lung opacification in the deceased group in which the lungs of older patients had less opacification than those of younger patients. The radiographic scores obtained by day 7 were the earliest ones with good performance in prognostic prediction. The model showed good discriminatory performance, indicated by high C-indexes for receiver operator characteristic curves (0.86 for AO% and 0.90 for the number of opacified zones). The predicted proportion of patients with fatal outcomes showed high agreement with percentage of patients who died (goodness-of-fit statistic p = 0.18 for AO%, 0.73 for the number of opacified zones). By day 7, crude odds ratio of death was 1.73 per 5% of AO% (p < 0.0001) or 2.93 per lung zone opacified (p < 0.0001). CONCLUSION. Chest radiographic scores (percentage of lung or the number of zones opacified) by day 7 could be used as fatal prognostic indicators.Keywords
This publication has 19 references indexed in Scilit:
- Severe acute respiratory syndrome: report of treatment and outcome after a major outbreakThorax, 2004
- Outcomes and Prognostic Factors in 267 Patients with Severe Acute Respiratory Syndrome in Hong KongAnnals of Internal Medicine, 2003
- Imaging in Severe Acute Respiratory Syndrome (SARS)Clinical Radiology, 2003
- Severe Acute Respiratory Syndrome: Relationship between Radiologic and Clinical ParametersRadiology, 2003
- Severe Acute Respiratory Syndrome: Radiographic Review of 40 Probable Cases in Toronto, CanadaRadiology, 2003
- Thin-Section CT of Severe Acute Respiratory Syndrome: Evaluation of 73 Patients Exposed to or with the DiseaseRadiology, 2003
- Severe Acute Respiratory Syndrome: Radiographic Appearances and Pattern of Progression in 138 PatientsRadiology, 2003
- Clinical Features and Short-term Outcomes of 144 Patients With SARS in the Greater Toronto AreaPublished by American Medical Association (AMA) ,2003
- Identification of Severe Acute Respiratory Syndrome in CanadaNew England Journal of Medicine, 2003
- Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective studyThe Lancet, 2003