Adults with symptoms of pneumonia: a prospective comparison of patients with and without infiltrates on chest radiography

Kristján Godsk Rögnvaldsson; Agnar Bjarnason; Inga Sif Ólafsdóttir; Kristján Orri Helgason; Aðalsteinn Guðmundsson; Magnús Gottfreðsson

doi:10.1016/j.cmi.2022.07.013

Adults with symptoms of pneumonia: a prospective comparison of patients with and without infiltrates on chest radiography

Kristján Godsk Rögnvaldsson, Agnar Bjarnason, Inga Sif Ólafsdóttir, Kristján Orri Helgason, Aðalsteinn Guðmundsson, Magnús Gottfreðsson^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVE: Most studies on patients hospitalized with community-acquired pneumonia (CAP) require confirmation of an infiltrate by chest radiography, but in practice admissions are common among patients with symptoms of pneumonia without an infiltrate (SPWI). The aim of this research was to compare clinical characteristics, microbial etiology, and outcomes among patients with CAP and SPWI.

METHODS: Adults suspected of CAP were prospectively recruited at Landspitali University Hospital over a 1-year period, 2018 to 2019. The study was population based. Those admitted with two or more of the following symptoms were invited to participate: temperature ≥38°C or ≤36°C, sweating, shaking/chills, chest pain, a new cough, or new onset of dyspnea. Primary outcome was mortality at 30 days and one year.

RESULTS: Six hundred twenty-five cases were included, 409 with CAP and 216 with SPWI; median age was 75 (interquartile range [IQR] 64-84) and 315 (50.4%) were females. Patients with CAP were more likely to have fever (≥38.0°C) (66.9% [273/408]) vs. 49.3% (106/215), p < 0.001), a higher CRP (median 103 [IQR 34-205] vs. 55 (IQR 17-103), p < 0.001), identification of Streptococcus pneumoniae (18.0% [64/355]) vs. 6.3% (10/159) of tested, p = 0.002) and to receive antibacterial treatment (99.5% [407/409]) vs. 87.5% (189/216), p < 0.001) but less likely to have a respiratory virus detected (25.4% [33/130]) vs. 51.2% (43/84) of tested, p < 0.001). The adjusted odds ratios for 30-day and 1 year mortality of SPWI compared to CAP were 0.86 (95% CI 0.40-1.86) and 1.46 (95% CI 0.92-2.32), respectively.

DISCUSSION: SPWI is a common cause of hospitalization and despite having fever less frequently, lower inflammatory markers, and lower detection rate of pneumococci than patients with CAP, mortality is not significantly different.

Original language	English
Pages (from-to)	108.e1-108.e6
Journal	Clinical Microbiology and Infection
Volume	29
Issue number	1
DOIs	https://doi.org/10.1016/j.cmi.2022.07.013
Publication status	Published - Jan 2023

Bibliographical note

Funding Information:
The authors thank the staff at the emergency wards of Landspitali–The National University Hospital of Iceland for assistance with patient recruitment and Salvör Rafnsdóttir for her contribution in terms of patient recruitment.

Funding Information:
This work was supported by The Icelandic Centre for Research (Rannís) (grant number 217716-051), The Doctoral Grants of The University of Iceland Research Fund, The Scientific fund of Landspitali- The National University Hospital of Iceland, The Scandinavian Society for Antimicrobial Chemotherapy Foundation, and the Foundation of St. Josef's Hospital. The funding sources had no role in the study's design, conduct or reporting.

Publisher Copyright:
© 2022 The Author(s)

Other keywords

Chest x-ray
Community-acquired pneumonia
Lower respiratory tract infections
Population-based
Prospective-study
Humans
Male
Viruses
Community-Acquired Infections/diagnostic imaging
Hospitalization
Streptococcus pneumoniae
Radiography
Adult
Female
Aged
Pneumonia/diagnostic imaging

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.cmi.2022.07.013

1-s2.0-S1198743X22003779-mainFinal published version, 491 KBLicence: CC BY-NC-ND

Cite this

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title = "Adults with symptoms of pneumonia: a prospective comparison of patients with and without infiltrates on chest radiography",

abstract = "OBJECTIVE: Most studies on patients hospitalized with community-acquired pneumonia (CAP) require confirmation of an infiltrate by chest radiography, but in practice admissions are common among patients with symptoms of pneumonia without an infiltrate (SPWI). The aim of this research was to compare clinical characteristics, microbial etiology, and outcomes among patients with CAP and SPWI.METHODS: Adults suspected of CAP were prospectively recruited at Landspitali University Hospital over a 1-year period, 2018 to 2019. The study was population based. Those admitted with two or more of the following symptoms were invited to participate: temperature ≥38°C or ≤36°C, sweating, shaking/chills, chest pain, a new cough, or new onset of dyspnea. Primary outcome was mortality at 30 days and one year.RESULTS: Six hundred twenty-five cases were included, 409 with CAP and 216 with SPWI; median age was 75 (interquartile range [IQR] 64-84) and 315 (50.4%) were females. Patients with CAP were more likely to have fever (≥38.0°C) (66.9% [273/408]) vs. 49.3% (106/215), p < 0.001), a higher CRP (median 103 [IQR 34-205] vs. 55 (IQR 17-103), p < 0.001), identification of Streptococcus pneumoniae (18.0% [64/355]) vs. 6.3% (10/159) of tested, p = 0.002) and to receive antibacterial treatment (99.5% [407/409]) vs. 87.5% (189/216), p < 0.001) but less likely to have a respiratory virus detected (25.4% [33/130]) vs. 51.2% (43/84) of tested, p < 0.001). The adjusted odds ratios for 30-day and 1 year mortality of SPWI compared to CAP were 0.86 (95% CI 0.40-1.86) and 1.46 (95% CI 0.92-2.32), respectively.DISCUSSION: SPWI is a common cause of hospitalization and despite having fever less frequently, lower inflammatory markers, and lower detection rate of pneumococci than patients with CAP, mortality is not significantly different.",

keywords = "Chest x-ray, Community-acquired pneumonia, Lower respiratory tract infections, Population-based, Prospective-study, Humans, Male, Viruses, Community-Acquired Infections/diagnostic imaging, Hospitalization, Streptococcus pneumoniae, Radiography, Adult, Female, Aged, Pneumonia/diagnostic imaging",

author = "R{\"o}gnvaldsson, {Kristj{\'a}n Godsk} and Agnar Bjarnason and {\'O}lafsd{\'o}ttir, {Inga Sif} and Helgason, {Kristj{\'a}n Orri} and A{\dh}alsteinn Gu{\dh}mundsson and Magn{\'u}s Gottfre{\dh}sson",

note = "Funding Information: The authors thank the staff at the emergency wards of Landspitali–The National University Hospital of Iceland for assistance with patient recruitment and Salv{\"o}r Rafnsd{\'o}ttir for her contribution in terms of patient recruitment. Funding Information: This work was supported by The Icelandic Centre for Research (Rann{\'i}s) (grant number 217716-051), The Doctoral Grants of The University of Iceland Research Fund, The Scientific fund of Landspitali- The National University Hospital of Iceland, The Scandinavian Society for Antimicrobial Chemotherapy Foundation, and the Foundation of St. Josef's Hospital. The funding sources had no role in the study's design, conduct or reporting. Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2023",

month = jan,

doi = "10.1016/j.cmi.2022.07.013",

language = "English",

volume = "29",

pages = "108.e1--108.e6",

journal = "Clinical Microbiology and Infection",

issn = "1198-743X",

publisher = "Elsevier B.V.",

number = "1",

}

TY - JOUR

T1 - Adults with symptoms of pneumonia

T2 - a prospective comparison of patients with and without infiltrates on chest radiography

AU - Rögnvaldsson, Kristján Godsk

AU - Bjarnason, Agnar

AU - Ólafsdóttir, Inga Sif

AU - Helgason, Kristján Orri

AU - Guðmundsson, Aðalsteinn

AU - Gottfreðsson, Magnús

N1 - Funding Information: The authors thank the staff at the emergency wards of Landspitali–The National University Hospital of Iceland for assistance with patient recruitment and Salvör Rafnsdóttir for her contribution in terms of patient recruitment. Funding Information: This work was supported by The Icelandic Centre for Research (Rannís) (grant number 217716-051), The Doctoral Grants of The University of Iceland Research Fund, The Scientific fund of Landspitali- The National University Hospital of Iceland, The Scandinavian Society for Antimicrobial Chemotherapy Foundation, and the Foundation of St. Josef's Hospital. The funding sources had no role in the study's design, conduct or reporting. Publisher Copyright: © 2022 The Author(s)

PY - 2023/1

Y1 - 2023/1

N2 - OBJECTIVE: Most studies on patients hospitalized with community-acquired pneumonia (CAP) require confirmation of an infiltrate by chest radiography, but in practice admissions are common among patients with symptoms of pneumonia without an infiltrate (SPWI). The aim of this research was to compare clinical characteristics, microbial etiology, and outcomes among patients with CAP and SPWI.METHODS: Adults suspected of CAP were prospectively recruited at Landspitali University Hospital over a 1-year period, 2018 to 2019. The study was population based. Those admitted with two or more of the following symptoms were invited to participate: temperature ≥38°C or ≤36°C, sweating, shaking/chills, chest pain, a new cough, or new onset of dyspnea. Primary outcome was mortality at 30 days and one year.RESULTS: Six hundred twenty-five cases were included, 409 with CAP and 216 with SPWI; median age was 75 (interquartile range [IQR] 64-84) and 315 (50.4%) were females. Patients with CAP were more likely to have fever (≥38.0°C) (66.9% [273/408]) vs. 49.3% (106/215), p < 0.001), a higher CRP (median 103 [IQR 34-205] vs. 55 (IQR 17-103), p < 0.001), identification of Streptococcus pneumoniae (18.0% [64/355]) vs. 6.3% (10/159) of tested, p = 0.002) and to receive antibacterial treatment (99.5% [407/409]) vs. 87.5% (189/216), p < 0.001) but less likely to have a respiratory virus detected (25.4% [33/130]) vs. 51.2% (43/84) of tested, p < 0.001). The adjusted odds ratios for 30-day and 1 year mortality of SPWI compared to CAP were 0.86 (95% CI 0.40-1.86) and 1.46 (95% CI 0.92-2.32), respectively.DISCUSSION: SPWI is a common cause of hospitalization and despite having fever less frequently, lower inflammatory markers, and lower detection rate of pneumococci than patients with CAP, mortality is not significantly different.

AB - OBJECTIVE: Most studies on patients hospitalized with community-acquired pneumonia (CAP) require confirmation of an infiltrate by chest radiography, but in practice admissions are common among patients with symptoms of pneumonia without an infiltrate (SPWI). The aim of this research was to compare clinical characteristics, microbial etiology, and outcomes among patients with CAP and SPWI.METHODS: Adults suspected of CAP were prospectively recruited at Landspitali University Hospital over a 1-year period, 2018 to 2019. The study was population based. Those admitted with two or more of the following symptoms were invited to participate: temperature ≥38°C or ≤36°C, sweating, shaking/chills, chest pain, a new cough, or new onset of dyspnea. Primary outcome was mortality at 30 days and one year.RESULTS: Six hundred twenty-five cases were included, 409 with CAP and 216 with SPWI; median age was 75 (interquartile range [IQR] 64-84) and 315 (50.4%) were females. Patients with CAP were more likely to have fever (≥38.0°C) (66.9% [273/408]) vs. 49.3% (106/215), p < 0.001), a higher CRP (median 103 [IQR 34-205] vs. 55 (IQR 17-103), p < 0.001), identification of Streptococcus pneumoniae (18.0% [64/355]) vs. 6.3% (10/159) of tested, p = 0.002) and to receive antibacterial treatment (99.5% [407/409]) vs. 87.5% (189/216), p < 0.001) but less likely to have a respiratory virus detected (25.4% [33/130]) vs. 51.2% (43/84) of tested, p < 0.001). The adjusted odds ratios for 30-day and 1 year mortality of SPWI compared to CAP were 0.86 (95% CI 0.40-1.86) and 1.46 (95% CI 0.92-2.32), respectively.DISCUSSION: SPWI is a common cause of hospitalization and despite having fever less frequently, lower inflammatory markers, and lower detection rate of pneumococci than patients with CAP, mortality is not significantly different.

KW - Chest x-ray

KW - Community-acquired pneumonia

KW - Lower respiratory tract infections

KW - Population-based

KW - Prospective-study

KW - Humans

KW - Male

KW - Viruses

KW - Community-Acquired Infections/diagnostic imaging

KW - Hospitalization

KW - Streptococcus pneumoniae

KW - Radiography

KW - Adult

KW - Female

KW - Aged

KW - Pneumonia/diagnostic imaging

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DO - 10.1016/j.cmi.2022.07.013

M3 - Article

C2 - 35872174

AN - SCOPUS:85137627325

SN - 1198-743X

VL - 29

SP - 108.e1-108.e6

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

IS - 1

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Adults with symptoms of pneumonia: a prospective comparison of patients with and without infiltrates on chest radiography

Abstract

Bibliographical note

Other keywords

UN SDGs

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