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

Early Access
Submitted: May 9, 2023
Accepted: June 8, 2023
Published: August 1, 2023
Acute cardiogenic pulmonary edema, ostial pulmonary veins, elderly, pneumonia
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Authors

Genki Inui
genki.inui@tottori-u.ac.jp
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
Department 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
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. 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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Citations

Crossref
Scopus
Google Scholar
Europe PMC
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. DOI: https://doi.org/10.1111/j.1365-2796.2006.01629.x
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. DOI: https://doi.org/10.1016/j.jacc.2009.10.021
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. DOI: https://doi.org/10.1177/2048872617700874
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. DOI: https://doi.org/10.1086/425615
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. DOI: https://doi.org/10.1016/j.rmed.2003.12.006
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. DOI: https://doi.org/10.1016/j.jinf.2013.03.003
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. DOI: https://doi.org/10.1183/1393003.congress-2017.PA4521
Ribeiro CMC, Marchiori E, Rodrigues R, et al. Hydrostatic pulmonary edema: high-resolution computed tomography aspects. J Bras Pneumol 2006;32:515–22. DOI: https://doi.org/10.1590/S1806-37132006000600008
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 Radio. 2014;6:230–7. DOI: https://doi.org/10.4329/wjr.v6.i6.230
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. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.590091
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. DOI: https://doi.org/10.1001/jama.278.17.1440
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. DOI: https://doi.org/10.1016/0021-9681(84)90149-8
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. DOI: https://doi.org/10.1080/01621459.1952.10483441
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. DOI: https://doi.org/10.1111/j.2517-6161.1995.tb02031.x
Akobeng AK. Understanding diagnostic tests 3: Receiver operating characteristic curves. Acta Paediatr 2007;96:644–7. DOI: https://doi.org/10.1111/j.1651-2227.2006.00178.x
Fagan TJ. Letter: Nomogram for Bayes theorem. N Engl J Med 1975;293:257. DOI: https://doi.org/10.1056/NEJM197507312930513
McGee S. Simplifying likelihood ratios. J Gen Intern Med 2002;17:646–9. DOI: https://doi.org/10.1046/j.1525-1497.2002.10750.x
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. DOI: https://doi.org/10.1001/archinte.159.9.970
Marx JA, Hockberger RS, Walls RM, et al. Rosen’s emergency medicine: concepts and clinical practice. Saunders, Philadelphia; 2014.
Maloney G, Anderson E, Yealy DM. Pneumonia and pulmonary infiltrates. In: Tintinalli JE, Stapczynski JS, et al., editors. Tintinalli’s Emergency medicine: a comprehensive study guide. McGraw-Hill Education, New York; 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. DOI: https://doi.org/10.1111/j.1532-5415.1983.tb06283.x
Ketai LH, Godwin JD. A new view of pulmonary edema and acute respiratory distress syndrome. J Thorac Imaging 1998;13:147–71. DOI: https://doi.org/10.1097/00005382-199807000-00001
van der Jagt EJ, Smits HJ. Cardiac size in the supine chestfilm. Eur J Radiol 1992;14:173–7. DOI: https://doi.org/10.1016/0720-048X(92)90080-S
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. DOI: https://doi.org/10.1148/radiographics.12.1.1734481
Fleischner FG, The butterfly pattern of acute pulmonary edema. Am J Cardiol 1967;20:39–46. DOI: https://doi.org/10.1016/0002-9149(67)90108-7
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. DOI: https://doi.org/10.3349/ymj.2014.55.6.1516
Hassani C, F. Saremi. Comprehensive cross-sectional imaging of the pulmonary veins. Radiographics 2017;37:1928–54. DOI: https://doi.org/10.1148/rg.2017170050

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, August. https://doi.org/10.4081/monaldi.2023.2633.
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