Differential diagnosis in patients with both features of pneumonia and pulmonary edema on chest computed tomography

Abstract

It is a common challenge for pneumonic consolidation and pulmonary edema/congestion to be presented simultaneously on computed tomography. However, there is a lack of research on the clinical features and differential diagnosis of patients suspected of heart failure (HF) and pneumonia (PN). Among patients presenting with dyspnea, chest computed tomography was performed, and those with pneumonia and pulmonary edema interpreted by radiologists were included for analysis. PN, HF, or HF with PN (HFPN) were categorized by the pulmonologist and cardiologist. Clinical features, c-reactive protein (CRP), procalcitonin, N-terminal pro-brain natriuretic peptide (NT-proBNP), and troponin I levels were collected. The study included 220 patients over 6 years, among whom 51.8% were ultimately confirmed as HFPN, with HF in 21.8% and PN in 26.4%. The HF group frequently exhibited cardiovascular risk factors, whereas the PN group showed no association with underlying pulmonary conditions. In multivariate analysis, independent biomarkers for HF diagnosis were NT-proBNP and CRP. The NT-proBNP was the only independent negative predictor for PN diagnosis. The combined model of CRP < 91 mg/dL and NT-proBNP > 2677 pg/mL were showed the highest diagnostic value (AUC 0.772, P = .033) for identifying HF. Both the HF-only and HFPN groups had high rates of antibiotic prescription, but this was not associated with in-hospital mortality. In this study, the combination of elevated NT-proBNP and low CRP levels appeared to provide better clinical utility in identifying HF over pneumonia among patients with overlapping radiologic features. However, further validation in diverse populations is warranted.