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

Vol. 94 No. 2 (2024)
Submitted: May 9, 2023
Accepted: June 8, 2023
Published: August 1, 2023
Acute cardiogenic pulmonary edema, ostial pulmonary veins, elderly, pneumonia
Abstract Views: 634
PDF: 75
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Authors

Genki Inui
https://orcid.org/0000-0002-5604-7487
Division 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, Tottori, Japan.
Katsuyuki Tomita
https://orcid.org/0000-0002-4050-775X
Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori, Japan.
Masaharu Fukuki
Department of Cardiologic Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori, Japan.
Hirokazu Touge
epartment of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori, Japan.
Tomoyuki Ikeuchi
Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori, Japan.
Ichiro Hisatome
https://orcid.org/0009-0001-8092-6983
Department of Cardiologic Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori, Japan.
Akira Yamasaki
yamasaki@tottori-u.ac.jp
https://orcid.org/0000-0001-5175-2729
Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan.

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.

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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.
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