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Severe Acute Respiratory Syndrome: Prognostic Implications of Chest Radiographic Findings in 52 Patients¹

¹ From the Department of Radiology (S.F.K., T.Y.L., C.C.H., Y.F.C., S.H.N., Y.L.K.), Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine (M.C.L.) and Infectious Diseases (J.W.L.), Department of Medical Research (K.D.Y.), Department of Public Health and Biostatistics (M.C.C.), and Department of Surgery (C.L.C.), Chang Gung University, Chang Gung Memorial Hospital at Kaouhsiung, 123 Ta-Pei Rd, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan. Received September 24, 2003; revision requested December 4; revision received December 11; accepted January 30, 2004. Address correspondence to S.F.K. (e-mail: sfatko@adm.cgmh.org.tw).

PURPOSE: To retrospectively assess prognostic implications of radiographic findings in severe acute respiratory syndrome (SARS).

MATERIALS AND METHODS: Radiographic findings were reviewed by two radiologists for 52 patients with SARS. On each radiograph, each lung was separated into upper, middle, and lower zones. A four-point scale was used to score extent of SARS-related lesions in each zone; points from all zones were added for a cumulative score. Patient sex, age, comorbidities, duration of developing lesions, lesion score for each radiograph, need for mechanical ventilation, and percentage of lung affected were compared between patients who died (n = 20) and survivors (n = 32). Continuous and categorical variables were analyzed with Mann-Whitney test and Fisher exact or ² test, respectively.

RESULTS: Survival and mortality groups showed no significant differences with respect to patient sex, duration of SARS-related lesions, development of lesion shifting, and acute respiratory distress syndrome. Patients who died were significantly older (mean ± standard deviation, 56.9 years ± 17.2 vs 40.4 years ± 16.6; P = .002) and had higher frequency of comorbid lung illnesses (nine of 20 vs two of 32, P = .001), maximal lesion extent score of 7 or higher (20 of 20 vs five of 32, P < .001), involvement of four or more lung zones (17 of 20 vs four of 32, P < .001), bilateral lung involvement (19 of 20 vs 14 of 32, P < .001), need for mechanical ventilation (18 of 20 vs two of 32, P < .001), and higher percentage of affected areas (41.5% ± 8.6 vs 16.4% ± 10.0, P < .001) than those of survivors.

CONCLUSION: On chest radiographs, maximal SARS-related lesion extent score of 7 or higher is a strong predictor of mortality, especially in patients with comorbid lung illnesses and involvement of four or more lung zones.

© RSNA, 2004

Index terms: Lung, diseases, 60.2069 • Severe acute respiratory syndrome, 60.2069

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