Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections.
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...
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doaj-399007bc04434831ba55f53875de08b92020-11-25T01:37:00ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01135e019741810.1371/journal.pone.0197418Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections.Ajay SheshadriDimpy P ShahMyrna GodoyJeremy J ErasmusJuhee SongLiang LiScott E EvansRoy F ChemalyBurton F DickeyDavid E OstBACKGROUND: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.http://europepmc.org/articles/PMC5957350?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ajay Sheshadri Dimpy P Shah Myrna Godoy Jeremy J Erasmus Juhee Song Liang Li Scott E Evans Roy F Chemaly Burton F Dickey David E Ost |
spellingShingle |
Ajay Sheshadri Dimpy P Shah Myrna Godoy Jeremy J Erasmus Juhee Song Liang Li Scott E Evans Roy F Chemaly Burton F Dickey David E Ost Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections. PLoS ONE |
author_facet |
Ajay Sheshadri Dimpy P Shah Myrna Godoy Jeremy J Erasmus Juhee Song Liang Li Scott E Evans Roy F Chemaly Burton F Dickey David E Ost |
author_sort |
Ajay Sheshadri |
title |
Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections. |
title_short |
Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections. |
title_full |
Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections. |
title_fullStr |
Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections. |
title_full_unstemmed |
Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections. |
title_sort |
progression of the radiologic severity index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2018-01-01 |
description |
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. |
url |
http://europepmc.org/articles/PMC5957350?pdf=render |
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