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Ryoo, Kim, Lee, Sohn, Seo, Lee, Lee, Oh, Kim, and Lim: Initial Chest CT Findings of 2009 H1N1 Influenza Pneumonia in Helping Predict Clinical Outcomes
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 69(2): 103-107.

Published online: 31 August 2010

DOI: https://doi.org/10.4046/trd.2010.69.2.103

Initial Chest CT Findings of 2009 H1N1 Influenza Pneumonia in Helping Predict Clinical Outcomes

Seung Mok Ryoo, M.D.1, Won Young Kim, M.D.1, Choong Wook Lee, M.D.2, Chang Hwan Sohn, M.D.1, Dong Woo Seo, M.D.1, Yoon Seon Lee, M.D., Ph.D.1, Jae Ho Lee, M.D.1, Bum Jin Oh, M.D.1, Won Kim, M.D., Ph.D.1, Kyoung Soo Lim, M.D., Ph.D.1

1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Won Young Kim, M.D. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3350, Fax: 82-2-3010-3360, wonpia@yahoo.co.kr

Received 25 May 2010       Accepted 6 August 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

The aim of the present study was to evaluate whether findings on initial chest computed tomography (CT) of influenza pneumonia can help predict clinical outcome.

Methods

We reviewed all adult patients admitted to the Emergency Department (ED) with a confirmed diagnosis of novel influenza A H1N1 virus (2009 H1N1) pneumonia, who underwent chest CT upon admission between Aug 26, 2009 and Jan 31, 2010. Radiologic findings were characterized by type and pattern of opacities and zonal distribution. Clinical outcome measures were intensive care unit (ICU) admission, mechanical ventilation, and inhospital death.

Results

Of 59 patients diagnosed with 2009 H1N1 pneumonia, 41 (69.5%) underwent chest CT on admission into ED. Nine (22%) of these patients developed adverse clinical outcomes requiring the following treatments: 9 (22.0%) ICU admissions, 5 (12.2%) mechanical ventilation, and 3 (7.3%) inhospital deaths. Counting the number of patients with more than 4 involved lobes, the sensitivity, specificity, positive predictive value, and negative predictive value for detection of adverse clinical outcome were 67%, 84%, 55% and 80%, respectively.

Conclusion

Extensive involvement of both lungs (over 4 lobes) is related to ICU admission, mechanical ventilation, and inhospital death. Initial chest CT may help predict an adverse clinical outcome of patients with 2009 H1N1 influenza pneumonia.

Keywords: Influenza A Virus, H1N1 Subtype, Tomography, X-Ray Computed, Respiration, Artificial, Mortality

Figures and Tables

Figure 1
Receiver operating characteristic (ROC) curve for numbers of involved lobe.
trd-69-103-g001
Table 1
Demographics and clinical characteristics
trd-69-103-i001

SD: standard deviation; BMI: body mass index; PSI: pneumonia severity score.

*Patients who were managed without intensive care unit (ICU) care or mechanical ventilation, †Patients who were managed with ICU care or mechanical ventilation.

Table 2
Computed tomographic findings
trd-69-103-i002

GGO: ground-glass opacity; SD: standard deviation.

*Patients who were managed without intensive care unit (ICU) care or mechanical ventilation, †Patients who were managed with ICU care or mechanical ventilation.

Table 3
Accuracy of the number of involved lobe and adverse outcome
trd-69-103-i003

CI: confidence interval; PPV: positive predictive value; NPV: negative predictive value.

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