Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study
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 pneu...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2023-08-01
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| Series: | Monaldi Archives for Chest Disease |
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| Online Access: | https://www.monaldi-archives.org/index.php/macd/article/view/2633 |
| _version_ | 1827888372557807616 |
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| author | Genki Inui Katsuyuki Tomita Masaharu Fukuki Hirokazu Touge Tomoyuki Ikeuchi Ichiro Hisatome Akira Yamasaki |
| author_facet | Genki Inui Katsuyuki Tomita Masaharu Fukuki Hirokazu Touge Tomoyuki Ikeuchi Ichiro Hisatome Akira Yamasaki |
| author_sort | Genki Inui |
| collection | DOAJ |
| description |
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. Ninety-three 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 vs 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.
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| first_indexed | 2024-03-12T20:33:45Z |
| format | Article |
| id | doaj.art-ec9bb1dc846148f5a94edefeede15cd5 |
| institution | Directory Open Access Journal |
| issn | 1122-0643 2532-5264 |
| language | English |
| last_indexed | 2024-03-12T20:33:45Z |
| publishDate | 2023-08-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Monaldi Archives for Chest Disease |
| spelling | doaj.art-ec9bb1dc846148f5a94edefeede15cd52023-08-01T18:32:41ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642023-08-0110.4081/monaldi.2023.2633Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational studyGenki Inui0Katsuyuki Tomita1Masaharu Fukuki2Hirokazu Touge3Tomoyuki Ikeuchi4Ichiro Hisatome5Akira Yamasaki6Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori; Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, TottoriDepartment of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, TottoriDepartment of Cardiologic Medicine, National Hospital Organization Yonago Medical Center, Yonago, TottoriDepartment of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, TottoriDepartment of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, TottoriDepartment of Cardiologic Medicine, National Hospital Organization Yonago Medical Center, Yonago, TottoriDivision of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori 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. Ninety-three 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 vs 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. https://www.monaldi-archives.org/index.php/macd/article/view/2633Acute cardiogenic pulmonary edemaostial pulmonary veinselderlypneumonia |
| spellingShingle | Genki Inui Katsuyuki Tomita Masaharu Fukuki Hirokazu Touge Tomoyuki Ikeuchi Ichiro Hisatome Akira Yamasaki 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 Acute cardiogenic pulmonary edema ostial pulmonary veins elderly pneumonia |
| title | Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study |
| title_full | Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study |
| title_fullStr | Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study |
| title_full_unstemmed | Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study |
| title_short | Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study |
| title_sort | clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community acquired pneumonia in elderly patients a prospective observational study |
| topic | Acute cardiogenic pulmonary edema ostial pulmonary veins elderly pneumonia |
| url | https://www.monaldi-archives.org/index.php/macd/article/view/2633 |
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