L-668. Radiological Cure in Adults with Mild-to-Moderate Community-acquired Pneumonia
Session: Poster Session: The World of Community-Acquired Pneumonia
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: Previously, we showed that resolution of abnormalities on chest X-ray (CXR) is very slow in severe community-acquired pneumonia (CAP) (mean PSI 113) and does not predict clinical cure, therefore a follow-up CXR in severe CAP should not be taken before 4 weeks.1 Now, we studied the rate of radiological cure compared to clinical cure in patients (pts) with mild-to-moderate CAP. Methods: 119 pts were followed for 28 days in a prospective multicenter study. Clinical and radiological cure was determined at day 10 and 28. Radiological cure was defined as the absence of infection-related CXR abnormalities, like infiltrates, pleural fluid or atelectasis. Clinical cure was defined by improvement of signs and symptoms. In addition, the CAP score, a patient based symptom score, was calculated. Results: All pts (mean age 56.6y; mean PSI 65.5) had pulmonary infiltrates on admission. Radiological and clinical cure rates were respectively 30.8% (n=33) and 93% (n=106) at day 10 and 68.4% (n=65) and 88.9% (n=96) at day 28. Pts with radiological cure had significantly higher CAP wellbeing scores at day 10 (62.5 vs. 50.1) and day 28 (71.6 vs. 59.9), p=0.02. In multivariable analysis, dyspnea on admission (OR 7.4, 95% CI 2.1-26.0) and PSI >90 (OR 4.7, 95% CI 1.3-16.9) were independently associated with delayed radiological cure, whereas pts with COPD had faster radiological cure (OR 0.3, 95% CI 0.1-0.8). During follow-up 12 (10.0%) pts developed complications of pneumonia, however none of these pts had deterioration of CXR without clinical signs. Conclusions: Radiological cure in mild-to-moderate CAP is about 30% after 10 days and 70% after one month and depends on pneumonia severity. Radiological cure lags behind clinical cure but is, in contrast to severe CAP, related to pts’ symptoms. Routine follow-up CXR in pts with mild-to-moderate CAP seems to have no additional value above following a pts’ clinical course.
1 Clin. Infect. Dis. 2007; 45(8): 983-91
Andy Hoepelman, MD, PhD1, Anke Bruns, MD2, Brent Opmeer, PhD3, Jan Prins, MD, PhD3, Jan Jelrik Oosterheert, Md, PhD1, Rachida El Mousaoui, MD, PhD3 and  A. H. W. Bruns, None., (1)University Medical Center, (2)University Medical Center, Utrecht, Netherlands, (3)Academic Medical Center