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PLoS One. 2018 May 17;13(5):e0197418. doi: 10.1371/journal.pone.0197418. eCollection 2018.

Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections.

Author information

1
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
2
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
3
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
4
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.

Abstract

BACKGROUND:

Radiologic severity may predict adverse outcomes after lower respiratory tract infection (LRI). However, few studies have quantified radiologic severity of LRIs. We sought to evaluate whether a semi-quantitative scoring tool, the Radiologic Severity Index (RSI), predicted mortality after parainfluenza virus (PIV)-associated LRI.

METHODS:

We conducted a retrospective review of consecutively-enrolled adult patients with hematologic malignancy or hematopoietic stem cell transplantation and with PIV detected in nasal wash who subsequently developed radiologically-confirmed LRI. We measured RSI (range 0-72) in each chest radiograph during the first 30 days after LRI diagnosis. We used extended Cox proportional hazards models to identify factors associated with mortality after onset of LRI with all-cause mortality as our failure event.

RESULTS:

After adjustment for patient characteristics, each 1-point increase in RSI was associated with an increased hazard of death (HR 1.13, 95% confidence interval [CI] 1.05-1.21, p = 0.0008). Baseline RSI was not predictive of death, but both peak RSI and the change from baseline to peak RSI (delta-RSI) predicted mortality (odds ratio for mortality, peak: 1.11 [95%CI 1.04-1.18], delta-RSI: 1.14 [95%CI 1.06-1.22]). A delta-RSI of ≥19.5 was 89% sensitive and 91% specific in predicting 30-day mortality.

CONCLUSIONS:

We conclude that the RSI offers precise, informative and reliable assessments of LRI severity. Progression of RSI predicts 30-day mortality after LRI, but baseline RSI does not. Our results were derived from a cohort of patients with PIV-associated LRI, but can be applied in validated in other populations of patients with LRI.

PMID:
29771962
PMCID:
PMC5957350
DOI:
10.1371/journal.pone.0197418
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Dr. Scott E. Evans and Dr. Burton F. Dickey are inventors of a technology to deliver aerosolized TLR ligands to induce resistance to microbial infection of the lungs; this technology has been licensed by MD Anderson Cancer Center to Pulmotect, Inc. (Houston, TX, USA), in which Dr. Evans and Dr. Dickey have ownership interests and which has sponsored research in the laboratories of Dr. Evans and Dr. Dickey. Dr. Roy F. Chemaly reports receiving research grants from Ansun Pharmaceuticals and Pulmotect, Inc. All other authors report no potential conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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