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Chest Radiograph Scores as Potential Prognostic Indicators in Severe Acute Respiratory Syndrome (SARS)

Gregory E. Antonio1, Ka T. Wong1, Eva L. H. Tsui2, David P. N. Chan1, David S. C. Hui3, Alex W. H. Ng1, Kwok K. Shing1, Edmund H. Y. Yuen1, Jane C. K. Chan4 and Anil T. Ahuja1

1 Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
2 Statistics and Research Unit, Hong Kong Hospital Authority, Hong Kong, China.
3 Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
4 Professional Services and Medical Development Division, Hong Kong Hospital Authority, Hong Kong, China.



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  		Fig. 1. —Diagram shows comparison of average percentage of total lung opacification in patients with fatal cases of SARS versus patients who recovered from SARS and were discharged. Percentages shown are for three zones (upper, middle, and lower) in each lung at five milestones in patients' treatment.

 


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  		Fig. 2A. —Graphs show radiographic profiles of lung opacification at five milestones of patients' treatment for patients with fatal cases of SARS versus patients who recovered from SARS and were discharged. Bars indicate interquartile range. Percentage area of lung opacification is plotted for patients with fatal SARS cases ({blacksquare} with solid line) and discharged patients ({square} with dotted line).

 


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  		Fig. 2B. —Graphs show radiographic profiles of lung opacification at five milestones of patients' treatment for patients with fatal cases of SARS versus patients who recovered from SARS and were discharged. Bars indicate interquartile range. Percentage area of lung opacification is plotted for two groups by sex. Male patients with fatal SARS = {blacksquare} with solid line, male patients who were discharged = {square} with dotted line, female patients with fatal SARS = S with solid line, female patients who were discharged ={triangleup} with dotted line.

 


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  		Fig. 2C. —Graphs show radiographic profiles of lung opacification at five milestones of patients' treatment for patients with fatal cases of SARS versus patients who recovered from SARS and were discharged. Bars indicate interquartile range. Percentage area of lung opacification is plotted for two groups by age. Patients 65 years and older with fatal SARS = {blacksquare} with solid line, patients 65 years and older who were discharged = {square} with dotted line, patients younger than 65 years with fatal SARS = S with solid line, patients younger than 65 years who were discharged = {triangleup} with dotted line.

 


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  		Fig. 3A. —Bar graphs show actual versus predicted proportion of deaths in each group as measured by Hosmer-Lemeshow goodness-of-fit test, which measures degree of agreement between predicted and observed death rates between groups of patients over entire range of risks. White bars represent percentage of actual deaths, and black bars represent percentage of predicted deaths. Graph shows actual (white bars) versus predicted (black bars) proportion of deaths analyzed by percentage of lung opacification by day 7 from symptom onset. Hosmer-Lemeshow goodness-of-fit test statistics = 1.7923 (p = 0.1806). Area under receiver operator characteristic curve = 0.864.

 


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  		Fig. 3B. —Bar graphs show actual versus predicted proportion of deaths in each group as measured by Hosmer-Lemeshow goodness-of-fit test, which measures degree of agreement between predicted and observed death rates between groups of patients over entire range of risks. White bars represent percentage of actual deaths, and black bars represent percentage of predicted deaths. Graph shows actual (white bars) versus predicted proportion of deaths (black bars) analyzed by number of zones opacified by day 7 of symptom onset. Hosmer-Lemeshow goodness-of-fit test statistics = 0.1217 (p = 0.7272). Area under receiver operator characteristic curve = 0.898.

 


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  		Fig. 4. —Graph of receiver operator characteristic (ROC) curve for outcome of death with respect to radiographic scores by day 7 from symptom onset shows how well model can discriminate between survivors and nonsurvivors. C-index for percentage of lung opacification = 0.867, C-index for number of zones opacified = 0.898. ROC curve for percentage of lung opacification = {blacksquare}, ROC curve for number of zones with lung opacification = {diamondsuit}.

 

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