Figures
- FIGURE 1
Receiver operating characteristic (ROC) curve of the low-dose computed tomography (LDCT) scan probabilities of a diagnosis of pneumonia compared with the reference diagnosis (area under the curve (AUC) 0.79 (95% CI 0.73–0.86)).
- FIGURE 2
Flowchart for patient pneumonia screening. CT: computed tomography; LDCT: low-dose CT.
Tables
- TABLE 1
Demographic and clinical characteristics of the 200 patients included in the PneumOLD-CT study at baseline
Characteristic# n (%) Median (IQR) Age years 84.0 (78.6–90.2) ≥85 years old 93 (46.5) Female 98 (49.0) Nursing home residents 28 (14.0) BMI kg·m−2 24.5 (21.5–28.6) Mini mental state examination score (N=162) 24 (19–27) Mini nutritional assessment (N=178) 8 (6–11) Functional independence measure score (N=171) 69 (50–97) Influenza vaccination within the past year (N=182) 103 (56.6) Pneumococcal vaccination within the past 5 years (N=177) 7 (4.0) Comorbidities Hospitalisation during the past 6 months 70 (35) Chronic cardiac disease 103 (51.5) COPD 35 (17.5) Kidney disease (N=199) 60 (30.2) Liver disease 11 (5.5) Neoplasia 17 (8.5) Smoking (past and present) 100 (50.0) History of stroke 33 (16.5) Cognitive disorders¶ 66 (33.0) Swallowing disorders+ 28 (14.0) Poor oral hygiene§ 38 (19.0) Immunosuppressive treatment (N=199)f 15 (7.5) Clinical characteristics of pneumonia Type of pneumonia Community-acquired pneumonia 162 (81.0) Nursing home-acquired pneumonia 22 (11.0) Hospital-acquired pneumonia (>72 h after hospitalisation) 16 (8.0) Bronchoaspiration (N=161)## 12 (7.5) Temperature ≥38.0 °C 116 (58.0) Cough 170 (85.0) Dyspnoea 145 (72.5) Sputum production 74 (37.0) Chest pain 35 (17.5) Crackles 171 (85.5) Decrease in respiratory sounds 51 (25.5) Peripheral oxygen saturation (SpO2 <90% on admission) 102 (51.0) Respiratory rate >20 per min on admission 143 (71.5) Delirium 92 (46.0) Fall 71 (35.5) CURB-65 score¶¶ 1 36 (18.0) 2 75 (37.5) 3 68 (34.0) 4 21 (10.5) Fine score 102 (89–123) Laboratory values and vital signs were obtained at hospital admission. IQR: interquartile range; BMI: body mass index; COPD: chronic obstructive pulmonary disease; SpO2: arterial oxygen saturation measured by pulse oximetry. #: the number of patients (N) is 200 unless otherwise stated; ¶: cognitive disorders were diagnosed after a cognitive consultation (at least clinical dementia rating (CDR) 1 dementia); +: swallowing disorders were observed during the hospitalisation; §: oral hygiene was defined as good, medium or poor; f: immunosuppressive treatment means that patient is under prednisone during more than 15 days or other immunosuppressive drugs; ##: bronchoaspiration was defined by the clinician according to usual definition; ¶¶: CURB-65 is a pneumonia severity score taking into account various factors (confusion, urea >7 mmol·L−1, respiratory rate ≥30 breaths·min−1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years).
- TABLE 2
Biological, microbiological and radiological characteristics at baseline, and treatment and outcome of the 200 patients included in the PneumOLD-CT study
Characteristics# n (%) Median (IQR) Biological White blood cell count 103 per mm3 (on admission) 11.0 (8.2–14.0) proBNP ng·L−1 (range <300 ng·L−1) (N=170) 1836 (667–3801) CRP mg·L−1 (range 0–10 mg·L−1) 84.0 (45.8–159.6) PCT µg·L−1 (range <0.25 µg·L−1) (N=185) 0.33 (0.13–1.30) Urea mmol·L−1 7.9 (6.0–11.9) Creatinine µmol·L−1 97.0 (77.0–133.0) Albumin g·L−1 (N=193) 35.0 (32.0–38.0) Prealbumin mg·L−1 (N=193) 122.0 (95.0–162.0) Microbiological Positive culture Blood (N=192) 11 (5.7) Urinary (N=177) 82 (46.3) Sputum (N=81) 36 (44.4) Pleural effusion (N=6) 0 Positive urinary antigen Legionella (N=183) 0 Pneumococcal (N=178) 8 (4.5) Positive serology (IgM) Legionella pneumophila 2 (1) Chlamydophila pneumoniae 4 (2) Mycoplasma pneumoniae 3 (1.5) Radiological Chest radiography Standing 66 (33) Two incidences 63 (31.5) Delay of LDCT chest scan h 2.2 (0.9–15.4) Radiologist's opinion on quality (good/satisfactory) 127 (63.5) Radiologist's estimate of pneumonia probability High 103 (51.5) Intermediate 23 (11.5) Low 74 (37.0) Treatment Duration of AT days 7 (6–9) Outcome Transfer to intermediate care unit or ICU 13 (7.0) 30-day mortality 11 (5.4) 90-day mortality 30 (15.0) IQR: interquartile range; proBNP: pro-brain natriuretic peptide; CRP: C-reactive protein; PCT: procalcitonin; IgM: immunoglobulin M; LDCT: low-dose computed tomography; AT: antimicrobial therapy; ICU: intensive care unit. #: the number of patients (N) is 200 unless otherwise stated.
- TABLE 3
Clinician's estimates of the probability of pneumonia in 200 patients before and after low-dose computed tomography (LDCT) chest scans
Clinician's estimates of the probability of pneumonia after LDCT Low Intermediate High Total Change of probability n % (95% CI) Clinician's estimates of the probability of pneumonia before LDCT Low 10 3 4 17 7 41 (18–24) Intermediate 34 13 23 70 57 81 (72–90) High 13 13 87 113 26 23 (15–31) Total 57 29 114 200 90 45 (38–52) Values in bold are for upgraded probability, while values in italic are for downgraded probability.
- TABLE 4
The net reclassification improvement (NRI) amongst 200 patients
Clinician's estimates of the probability of pneumonia after LDCT Net reclassification Excluded/
lowIntermediate/
high/certainTotal Patients with pneumonia according to the adjudication committee (n=143) Clinician's estimates of the probability of pneumonia before LDCT Net reclassification=6–18 = –12 patients (–8.4% of the 143 patients with pneumonia) Excluded/low 2 6 Intermediate/high/certain 18 117 Total 143 Patients without pneumonia according to the adjudication committee (n=57) Clinician's estimates of the probability of pneumonia before LDCT Net reclassification=29–1 = +28 patients (+49.1% of the 57 patients without pneumonia) Excluded/low 8 1 Intermediate/high/certain 29 19 Total 57 Total patients 200 Absolute NRI=28–12 = +16 patients (8.0% of all 200 patients) The values in bold show patients correctly reclassified by the new model, while the values in italic show patients incorrectly reclassified by the new model. The absolute number of patients correctly reclassified is –12 patients among those with pneumonia and +28 patients among those without pneumonia. Overall, the absolute number of patients correctly reclassified is thus +16 patients, which corresponds to 8.0% of all patients in the sample. LDCT: low-dose computed tomography.
- TABLE 5
Additional findings following analysis of low-dose computed tomography (LDCT) chest scans
Additional findings n Total findings 76 Pulmonary findings 51 Pleural effusion 22 Pulmonary nodules 19 Lung mass 1 Lung metastases 1 Emphysema 5 Lung fibrosis 1 Asbestosis 1 Tuberculosis sequelae 1 Other findings 28 Adenomegalies 7 Hepatic lesions 5# Adrenal nodules 4 Pericardial effusion 3 Abdominal aortic aneurysm 3 Renal cysts 2 Thyroid nodules 1 Fractures 3 The same patient could have more than one finding. #: including one hepatic abscess.
Supplementary Material
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Appendix ERJ-02375-2017_Appendix
