The American journal of medicine · 2026
Pulmonary artery diameter predicts mortality in community-acquired pneumonia.
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Kenig Ariel, Sigawi Tal, Bachrach Yonatan, Malul Yehuda, Darawshy Fares, Azmanov Henny, Kuint Rottem, Padawer Dan, Alsharif Nuha, Fridlender Zvi G, Berkman Neville
Аннотация
BACKGROUND: The impact of pneumonia on pulmonary hemodynamics may be underestimated by available risk scores, such as CURB-65 and the Pneumonia Severity Index (PSI). We evaluated the prognostic utility of pulmonary artery diameter (PAD) in pneumonia.
METHODS: We retrospectively screened 1,887 CT pulmonary angiography scans. Pneumonia was defined as a pulmonary infiltrate accompanied by clinical or laboratory evidence of infection. Patients' characteristics and outcomes were extracted from medical records. PAD was measured using three methods (PAD1-3) and tested for association with mortality.
RESULTS: A total of 243 pneumonia cases were included. PAD1-3 showed strong inter-method agreement (ICC = 0.88, P < 0.0001). PAD1 showed the most consistent association with mortality and was widely applicable. PAD1 was larger in non-survivors at 30 days (29.6 versus 26.4 mm, P = 0.0003), 90 days (28.5 versus 26.4 mm, P = 0.002), and one year (28.0 versus 26.4 mm, P = 0.01). Thirty-day mortality increased stepwise across PAD1 tertiles (3.8%, 13.9%, and 22.8%, P = 0.001), as did 90-day and one-year mortality. PAD1 was an independent predictor of 30-day mortality (HR 1.11 per mm, 95% CI 1.02-1.22, P = 0.02). PAD1, CURB-65, and PSI showed comparable performance in predicting 30-day mortality (ROC-AUC = 0.70-0.73).
CONCLUSIONS: PAD is independently associated with mortality in pneumonia and demonstrates comparable predictive performance to CURB-65 and PSI for 30-day mortality. These findings support incorporating vascular imaging markers into risk stratification scores.
METHODS: We retrospectively screened 1,887 CT pulmonary angiography scans. Pneumonia was defined as a pulmonary infiltrate accompanied by clinical or laboratory evidence of infection. Patients' characteristics and outcomes were extracted from medical records. PAD was measured using three methods (PAD1-3) and tested for association with mortality.
RESULTS: A total of 243 pneumonia cases were included. PAD1-3 showed strong inter-method agreement (ICC = 0.88, P < 0.0001). PAD1 showed the most consistent association with mortality and was widely applicable. PAD1 was larger in non-survivors at 30 days (29.6 versus 26.4 mm, P = 0.0003), 90 days (28.5 versus 26.4 mm, P = 0.002), and one year (28.0 versus 26.4 mm, P = 0.01). Thirty-day mortality increased stepwise across PAD1 tertiles (3.8%, 13.9%, and 22.8%, P = 0.001), as did 90-day and one-year mortality. PAD1 was an independent predictor of 30-day mortality (HR 1.11 per mm, 95% CI 1.02-1.22, P = 0.02). PAD1, CURB-65, and PSI showed comparable performance in predicting 30-day mortality (ROC-AUC = 0.70-0.73).
CONCLUSIONS: PAD is independently associated with mortality in pneumonia and demonstrates comparable predictive performance to CURB-65 and PSI for 30-day mortality. These findings support incorporating vascular imaging markers into risk stratification scores.