Highlights • Radiographic score can play a pivotal role for patients with MERS pneumonia. • The cutoff radiographic (RG) score is 10 on 10th day from MERS-CoV exposure. • Patients with RG score above the cutoff are prone to show respiratory distress. • Patients with RG score above 10 on 10 th day from viral exposure need aggressive care. The aim of this study is to determine the earliest cutoff of radiographic score as a potential prognostic indicator of fatal outcomes in patients with acute Middle East respiratory syndrome coronavirus (MERS-CoV) pneumonia. The institutional review board approved this retrospective study. Serial chest radiographies (CXRs) were obtained from viral exposure until death or discharge in 35 patients with laboratory confirmed MERS-CoV infection. Radiographic scores were calculated by multiplying a four-point scale of involved lung area and three-point scale of abnormal opacification, in each of the six lung zones. Receiver operating characteristics (ROC) analyses were performed to identify optimal day and radiographic score for the prediction of respiratory distress, and univariate and multivariate logistic regression analyses were performed to assess significant predictive factors for intubation or tracheostomy. Among 35 patients (22 men, 13 women; median age: 48 years), 25 demonstrated abnormal opacity on CXR (MERS pneumonia), whereas no abnormality was detected in 10 patients (MERS upper respiratory tract infection). Seven patients required ventilator support (intubation group) and three of them eventually expired. The average incubation period was 5.4 days (standard deviation, ±2.8; range, 2–11). Patients in the intubation group had a higher incidence of diffuse lung involvement, higher radiographic scores, and fibrosing sequela on follow up study compared with those in the non-intubation group. However, patients’ age and comorbidity did not differ significantly between the two groups. The ROC analysis revealed an area under curve of 0.726 for the radiographic score on day 10 with an optimal cutoff score of 10 for prediction of intubation, with a sensitivity of 71% and specificity of 67%. Our study suggest that MERS patients with radiographic score > 10 on day 10 from viral exposure require aggressive therapy with careful surveillance and follow-up evaluation.
【저자키워드】 Chest radiograph, ROC, Receiver Operating Characteristic, MERS, Middle East respiratory syndrome, CT, Computed tomography, CoV, coronavirus, prognostic indicator, Middle East respiratory syndrome coronavirus (MERS-CoV), chest radiographic score, AUC, area under the ROC curve, CXR, chest radiography, ER, emergency room, URI, upper respiratory tract infection,