Abstract
BackgroundViruses are increasingly recognized as major causes of community-acquired pneumonia (CAP). Few studies have investigated the clinical predictors of viral pneumonia, and the results have been inconsistent. In this study, the clinical predictors of viral pneumonia were investigated in terms of their utility as indicators for viral pneumonia in patients with CAP.MethodsAdult patients (≥18 years old) with CAP, tested by polymerase chain reaction (PCR) for respiratory virus, at two teaching hospitals between October 2010 and May 2013, were identified retrospectively. Demographic and clinical data were collected by reviewing the hospital electronic medical records.ResultsDuring the study period, 456 patients with CAP were identified who met the definition, and 327 (72%) patients were tested using the respiratory virus PCR detection test. Viral pneumonia (n = 60) was associated with rhinorrhea, a higher lymphocyte fraction in the white blood cells, lower serum creatinine and ground-glass opacity (GGO) in radiology results, compared to non-viral pneumonia (n = 250) (p<0.05, each). In a multivariate analysis, rhinorrhea (Odd ratio (OR) 3.52; 95% Confidence interval (CI), 1.58–7.87) and GGO (OR 4.68; 95% CI, 2.48–8.89) were revealed as independent risk factors for viral pneumonia in patients with CAP. The sensitivity, specificity, positive- and negative-predictive values (PPV and NPV) of rhinorrhea were 22, 91, 36 and 83%: the sensitivity, specificity, PPV and NPV of GGO were and 43, 84, 40 and 86%, respectively.ConclusionSymptom of rhinorrhea and GGO predicted viral pneumonia in patients with CAP. The high specificity of rhinorrhea and GGO suggested that these could be useful indicators for empirical antiviral therapy.
Highlights
communityacquired pneumonia (CAP) remains a significant cause of morbidity and mortality [1, 2]
Among 327 patients, respiratory viruses were detected in 60 (18%) patients, while 250 (76%) patients were diagnosed with non-viral pneumonia with negative polymerase chain reaction (PCR) results, and 17 (5%) patients were diagnosed as being co-infected with a virus and bacteria
Rhinorrhea and the GGO radiologic pattern were independently associated with viral pneumonia, and were specific predictors of viral pneumonia in patients with CAP
Summary
The development and application of diagnostic tests with improved sensitivity, such as the polymerase chain reaction (PCR), have led to recognition of the increasing role of respiratory viruses in CAP in all age groups [3]. The original studies included in the Cochrane review did not include people with severe underlying disorders or patients with a severe presentation of influenza For this reason, no conclusion can be made on the efficacy of antiviral treatment for viral pneumonia by the Cochrane review [19]. There is evidence of efficacy in the treatment of influenza pneumonia [20,21,22], and early empirical antiviral therapy is still recommended in critically ill patients in whom viral pneumonia is suspected [7]. The high specificity of rhinorrhea and GGO suggested that these could be useful indicators for empirical antiviral therapy
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