https://doi.org/10.4081/monaldi.2023.2633
Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study
Submitted: May 9, 2023
Accepted: June 8, 2023
Published: August 1, 2023
Accepted: June 8, 2023
Abstract Views: 756
PDF: 191
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Heart failure and pneumonia are highly prevalent in elderly patients. We conducted a study to evaluate the differences in the patterns of symptoms, laboratory findings, and computed tomography (CT) results in elderly patients with acute cardiogenic pulmonary edema (ACPE) and community-acquired pneumonia (CAP). From January 1, 2015, to December 31, 2017, we studied 140 patients aged >75 years who were diagnosed with ACPE and CAP. Symptoms, laboratory findings, mean ostial pulmonary vein (PV) diameter and patterns on CT images were assessed. The primary measures of diagnostic accuracy were assessed using the positive likelihood ratio (LR+). The cutoff value of ostial PVs for differentiating patients with ACPE from CAP was evaluated using the receiver operating characteristic (ROC) analysis. 93 patients with ACPE, 36 with CAP, and 11 with complicated ACPE/CAP were included. In patients with ACPE, edema (LR+ 5.4) was a moderate factor for rule-in, and a high brain natriuretic peptide level (LR+ 4.2) was weak. In patients with CAP, cough (LR+ 5.7) and leukocytosis (LR+ 5.2) were moderate factors for rule-in, while fever (LR+ 3.8) and a high C-reactive protein level (LR+ 4.8) were weak factors. The mean diameter of ostial PVs in patients with ACPE was significantly larger than that of patients with CAP (15.8± 1.8 mm versus 9.6±1.5 mm, p< 0.01). ROC analysis revealed that an ostial PV diameter cutoff of 12.5 mm was strong evidence for distinguishing ACPE from CAP, with an area under the ROC curve of 0.99 and LR+ 36.0. In conclusion, as ACPE and CAP have similar symptoms and laboratory findings, dilated ostial PVs were useful in characterizing CT images to distinguish ACPE from CAP.
Thomsen RW, Riis A, Nørgaard M, et al. Rising incidence and persistently high mortality of hospitalized pneumonia: a 10-year population-based study in Denmark. J Intern Med 2006;259:410-7.
Casper M, Nwaise I, Croft JB, et al. Geographic disparities in heart failure hospitalization rates among Medicare beneficiaries. J Am Coll Cardiol 2010;55:294-9.
Jobs A, Simon R, Waha S, et al. Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients. Eur Heart J Acute Cardiovasc Care 2018;7:362-70.
Jackson ML, Neuzil KM, Thompson WW, et al. The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis 2004;39:1642-50.
Alves dos Santos JW, Torres A, Michel GT, et al. Non-infectious and unusual infectious mimics of community-acquired pneumonia. Respir Med 2004;98:488-94.
Musher DM, Roig IL, Cazares G, et al. Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: results of a one-year study. J Infect 2013;67:11-8.
Andrey Bobylev SR, Avdeev S, Mladov V. Diagnosis on community-acquired pneumonia (CAP) in patients with congestive heart failure (CHF). Eur Respir J 2017;50:PA4521.
Ribeiro CMC, Marchiori E, Rodrigues R, et al. Hydrostatic pulmonary edema: high-resolution computed tomography aspects. J Bras Pneumol 2006;32:515-22.
Cardinale L, Priola AM, Moretti F, Volpicelli G. Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure. World J Radiol 2014;6:230-7.
Gao L, Lu C, Yin M, et al. Increased ostial pulmonary vein diameter in congestive heart failure: a multi-slice computed tomography angiography evaluation. J Geriatr Cardiol 2006;3:45-50.
Gheorghiade M, Zannad F, Sopko G, et al. Acute heart failure syndromes: current state and framework for future research. Circulation 2005;112:3958-68.
Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA 1997;278:1440-5.
Diehr P, Wood RW, Bushyhead J, et al. Prediction of pneumonia in outpatients with acute cough--a statistical approach. J Chronic Dis 1984;37:215-25.
Ebell MH. Predicting pneumonia in adults with respiratory illness. Am Fam Physician 2007;76:560-2.
Kruskal WH, Wallis WA. Use of ranks in one-criterion variance analysis. J Am Stat Assoc1952;47:583-621.
Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Stat Soc B Meth 1995;57:289-300.
Akobeng AK. Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 2007;96:644-7.
Fagan TJ. Letter: nomogram for Bayes theorem. N Engl J Med 1975;293:257.
McGee S. Simplifying likelihood ratios. J Gen Intern Med 2002;17:646-9.
Fine MJ, Stone RA, Singer DE, et al. Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study. Arch Intern Med 1999;159:970-80.
Marx JA, Hockberger RS, Walls RM, et al. Rosen’s emergency medicine: concepts and clinical practice. Philadelphia, PA, USA: Saunders; 2014.
Maloney G, Anderson E, Yealy DM. Pneumonia and pulmonary infiltrates. In: Tintinalli JE, Stapczynski JS, Ma OJ, et al., eds. Tintinalli’s Emergency medicine: a comprehensive study guide. New York, NY, USA: McGraw-Hill Education; 2016.
Finkelstein MS, Petkun WM, Freedman ML, Antopol SC. Pneumococcal bacteremia in adults: age-dependent differences in presentation and in outcome. J Am Geriatr Soc 1983;31:19-27.
Ketai LH, Godwin JD. A new view of pulmonary edema and acute respiratory distress syndrome. J Thorac Imaging 1998;13:147-71.
van der Jagt EJ, Smits HJ. Cardiac size in the supine chestfilm. Eur J Radiol 1992;14:173-7.
Bessis L, Callard P, Gotheil C, et al. High-resolution CT of parenchymal lung disease: precise correlation with histologic findings. Radiographics 1992;12:45-58.
Fleischner FG, The butterfly pattern of acute pulmonary edema. Am J Cardiol 1967;20:39-46.
Lee JM, Kim JY, Shim J, et al. Characteristics of pulmonary vein enlargement in non-valvular atrial fibrillation patients with stroke. Yonsei Med J 2014;55:1516-25.
Hassani C, Saremi F. Comprehensive cross-sectional imaging of the pulmonary veins. Radiographics 2017;37:1928-54.
Ethics Approval
This study protocol was reviewed and approved by the Ethical Review Board of Yonago Medical Center (approval number: 0408-02).How to Cite
Inui, Genki, Katsuyuki Tomita, Masaharu Fukuki, Hirokazu Touge, Tomoyuki Ikeuchi, Ichiro Hisatome, and Akira Yamasaki. 2023. “Clinical Characteristics for Distinguishing Between Acute Cardiogenic Pulmonary Edema and Community-Acquired Pneumonia in Elderly Patients: A Prospective Observational Study”. Monaldi Archives for Chest Disease 94 (2). https://doi.org/10.4081/monaldi.2023.2633.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Hassan H. Allam, Abdulhalim J. kinsara, Amtalkhaliq Alrajawi , Tareq Tuaima, Olga Vriz, Transverse sinus mass misinterpreted as the source of cardiac emboli , Monaldi Archives for Chest Disease: Vol. 91 No. 1 (2021)
- Carmine Guarino, Cristiano Cesaro, Giuseppe Fiorentino, Francesco Rossi, Benedetto Maria Polverino, Fiorentino Fragranza, Luca Monastra, Patrizia Murino, Enzo Zamparelli, Giuseppe La Cerra, Bronchoscopy in COVID-19 patients: When, how and why. Experience in clinical practice , Monaldi Archives for Chest Disease: Vol. 91 No. 2 (2021)
- Antonietta Coppola, Anna Annunziata, Maria Rosaria Gioia, Giuseppe Fiorentino, Bleeding events in COVID-19: the other side of the coin? , Monaldi Archives for Chest Disease: Vol. 91 No. 3 (2021)
- Aiswarya M Nair, Sowmya Gopalan, Vaasanthi Rajendran, Priyadarshini Varadaraj , Lakshmi Marappa , Viswanathan Pandurangan , Sudha Madhavan, Rajkumar Mani , Emmanuel Bhaskar , Role of secondary sepsis in COVID-19 mortality: Observations on patients with preexisting diabetes mellitus and newly diagnosed hyperglycemia , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- Iqbal Akhtar Khan, Paola Pierucci, Nicolino Ambrosino, COPD patients’ pre-flight check: A narrative review , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- Martina Turrin, Francesca Maria Pontoriero, Giulia Grisostomi, Giordano Fiorentù, Francesca Zampieri, Francesca Savoia, Cosimo Catino, Giuseppe Zanardi, Piera Peditto, Nicola Malacchini, Fabiola Zeraj, Matteo Bonato, Diana Sacchi, Maria Guido, Giovanni Morana, Micaela Romagnoli, Tracheal atypical solitary carcinoid in a so-called “difficult asthma”: a diagnostic challenge , Monaldi Archives for Chest Disease: Vol. 94 No. 2 (2024)
- Laura Bertacchini, Mara Paneroni, Laura Comini, Simonetta Scalvini, Michele Vitacca, Recovering of oxygenation, physical function and disability in patients with Covid-19 , Monaldi Archives for Chest Disease: Vol. 91 No. 4 (2021)
- Maya Gopalakrishnan, Satyendra Khichar, Suman Saurabh, Parag Vijayvergia, Karthikeyan Thangaraju, Swapnil Tripathi, Harshavardhan V. Devarakonda, Akhilesh Kumar , Pranav S. Kumar, Mahendra Kumar Garg , Effectiveness of early awake self proning strategy in non-intubated patients with COVID-19 hypoxemia: an open-labelled randomized clinical trial from Jodhpur, India , Monaldi Archives for Chest Disease: Vol. 93 No. 4 (2023)
- Angelica Cersosimo, Mauro Riccardi, Ludovica Amore, Giuliana Cimino, Gianmarco Arabia, Marco Metra, Enrico Vizzardi, Varicella zoster virus and cardiovascular diseases , Monaldi Archives for Chest Disease: Vol. 93 No. 2 (2023)
- Davide Tarello, Francesca Giogà, Andrea Lauterio, Chiara Becchetti, Giovanni Perricone, Giorgio Santi, Monica Ragazzi, Gianpaola Monti, Marta Lazzeri, Respiratory and physical therapy in the intensive care unit after liver transplantation for acute-on-chronic liver failure: a case report , Monaldi Archives for Chest Disease: Early Access
<< < 51 52 53 54 55 56 57 58 59 60 > >>
You may also start an advanced similarity search for this article.
