Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort

Congestion score index (CSI), a semiquantitative evaluation of congestion on chest radiography (CXR), is associated with outcome in patients with heart failure (HF). However, its diagnostic value in patients admitted for acute dyspnea has yet to be evaluated. The diagnostic value of CSI for acute HF...

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Bibliographic Details
Published in:PLoS medicine 2020-11, Vol.17 (11), p.e1003419-e1003419
Main Authors: Kobayashi, Masatake, Douair, Amine, Duarte, Kevin, Jaeger, Déborah, Giacomin, Gaetan, Bassand, Adrien, Jeangeorges, Victor, Abensur Vuillaume, Laure, Preud'homme, Gregoire, Huttin, Olivier, Zannad, Faiez, Rossignol, Patrick, Chouihed, Tahar, Girerd, Nicolas
Format: Article
Language:English
Subjects:
Acidosis
Acute Disease
Adolescent
Aged
Biology and Life Sciences
Brain natriuretic peptide
Cardiology
Cardiology and cardiovascular system
Care and treatment
Chest
Chronic obstructive pulmonary disease
Cohort Studies
Comorbid patients
Comorbidity
Complications and side effects
Congestive heart failure
Demographic aspects
Diagnosis
Disease management
Dyspnea
Dyspnea - complications
Dyspnea - diagnosis
Edema
Emergencies
Emergency medical care
Emergency service
Emergency Service, Hospital
Female
France
Health care access
Heart failure
Heart Failure - diagnosis
Heart Failure - epidemiology
Hospitalization - statistics & numerical data
Hospitals
Human health and pathology
Humans
Life Sciences
Male
Medical examination
Medicine and Health Sciences
Middle Aged
Mortality
Patient outcomes
Patients
Peptides
Pleural effusion
Pneumonia
Pulmonary edema
Radiography
Radiography - statistics & numerical data
Reclassification
Renal function
Reproducibility
Respiration
Retrospective Studies
Risk factors
ROC Curve
Shortness of breath
Statistics
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Description
Summary:Congestion score index (CSI), a semiquantitative evaluation of congestion on chest radiography (CXR), is associated with outcome in patients with heart failure (HF). However, its diagnostic value in patients admitted for acute dyspnea has yet to be evaluated. The diagnostic value of CSI for acute HF (AHF; adjudicated from patients' discharge files) was studied in the Pathway of dyspneic patients in Emergency (PARADISE) cohort, including patients aged 18 years or older admitted for acute dyspnea in the emergency department (ED) of the Nancy University Hospital (France) between January 1, 2015 and December 31, 2015. CSI (ranging from 0 to 3) was evaluated using a semiquantitative method on CXR in consecutive patients admitted for acute dyspnea in the ED. Results were validated in independent cohorts (N = 224). Of 1,333 patients, mean (standard deviation [SD]) age was 72.0 (18.5) years, 686 (51.5%) were men, and mean (SD) CSI was 1.42 (0.79). Patients with higher CSI had more cardiovascular comorbidities, more severe congestion, higher b-type natriuretic peptide (BNP), poorer renal function, and more respiratory acidosis. AHF was diagnosed in 289 (21.7%) patients. CSI was significantly associated with AHF diagnosis (adjusted odds ratio [OR] for 0.1 unit CSI increase 1.19, 95% CI 1.16-1.22, p < 0.001) after adjustment for clinical-based diagnostic score including age, comorbidity burden, dyspnea, and clinical congestion. The diagnostic accuracy of CSI for AHF was >0.80, whether alone (area under the receiver operating characteristic curve [AUROC] 0.84, 95% CI 0.82-0.86) or in addition to the clinical model (AUROC 0.87, 95% CI 0.85-0.90). CSI improved diagnostic accuracy on top of clinical variables (net reclassification improvement [NRI] = 94.9%) and clinical variables plus BNP (NRI = 55.0%). Similar diagnostic accuracy was observed in the validation cohorts (AUROC 0.75, 95% CI 0.68-0.82). The key limitation of our derivation cohort was its single-center and retrospective nature, which was counterbalanced by the validation in the independent cohorts. In this study, we observed that a systematic semiquantified assessment of radiographic pulmonary congestion showed high diagnostic value for AHF in dyspneic patients. Better use of CXR may provide an inexpensive, widely, and readily available method for AHF triage in the ED.
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1003419