• Tai-Nin Chau, Po-Oi Lee, Kin-Wing Choi, Chiu-Man Lee, Ka-Fai Ma, Tak-Yin Tsang, Yuk-Keung Tso, Ming-Chee Chiu, Wing-Lok Tong, Wai-Cho Yu, and Sik-To Lai.
• Department of Medicine and Geriatrics, Princess Margaret Hospital, Lai Chi Kok, Hong Kong Special Administrative Region. chautainin@hotmail.com
• Am. J. Med. 2004 Aug 15; 117 (4): 249254249-54.

PurposeTo determine whether the initial chest radiograph is helpful in predicting the clinical outcome of patients with severe acute respiratory syndrome (SARS).MethodsOf 343 patients who met the World Health Organization's case definition of probable SARS and who had been admitted to a regional hospital in Hong Kong, 201 patients had laboratory evidence of SARS coronavirus infection. The initial frontal chest radiographs of these 201 patients were assessed in a blinded fashion by 3 radiologists; individual findings were accepted if at least 2 of the radiologists concurred. Independent predictors of an adverse outcome, defined as the need for assisted ventilation, death, or both, were identified by multivariate analysis.ResultsBilateral disease and involvement of more than two zones on the initial chest radiograph were associated with a higher risk of liver impairment and poor clinical outcome. Forty-two patients (21%) developed an adverse outcome. Multivariate analysis showed that lung involvement of more than two zones (odds ratio [OR] = 7.0; 95% confidence interval [CI]: 2.7 to 17.9), older age (OR for each decade of life = 1.5; 95% CI: 1.1 to 2.0), and shortness of breath on admission (OR = 2.8; 95% CI: 1.1 to 7.4) were independent predictors of an adverse outcome.ConclusionFrontal chest radiographs on presentation may have prognostic value in patients with SARS.

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