{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T23:49:34Z","timestamp":1792972174233,"version":"4.5.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,10,12]],"date-time":"2019-10-12T00:00:00Z","timestamp":1570838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,10,12]],"date-time":"2019-10-12T00:00:00Z","timestamp":1570838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["T32 HL007633"],"award-info":[{"award-number":["T32 HL007633"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K08 HL145118"],"award-info":[{"award-number":["K08 HL145118"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01 HL112747-01"],"award-info":[{"award-number":["R01 HL112747-01"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K08 GM1026965"],"award-info":[{"award-number":["K08 GM1026965"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Respir Res"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Respiratory pathology is a major driver of mortality in the intensive care unit (ICU), even in the absence of a primary respiratory diagnosis. Prior work has demonstrated that a visual scoring system applied to chest radiographs (CXR) is associated with adverse outcomes in ICU patients with Acute Respiratory Distress Syndrome (ARDS). We hypothesized that a simple, semi-quantitative CXR score would be associated with clinical outcomes for the general ICU population, regardless of underlying diagnosis.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>All individuals enrolled in the Registry of Critical Illness at Brigham and Women\u2019s Hospital between June 2008 and August 2018 who had a CXR within 24\u2009h of admission were included. Each patient\u2019s CXR was assigned an opacification score of 0\u20134 in each of four quadrants with the total score being the sum of all four quadrants. Multivariable negative binomial, logistic, and Cox regression, adjusted for age, sex, race, immunosuppression, a history of chronic obstructive pulmonary disease, a history of congestive heart failure, and APACHE II scores, were used to assess the total score\u2019s association with ICU length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, 60-day mortality, and overall mortality, respectively.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 560 patients were included. Higher CXR scores were associated with increased mortality; for every one-point increase in score, in-hospital mortality increased 10% (OR 1.10, CI 1.05\u20131.16, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and 60-day mortality increased by 12% (OR 1.12, CI 1.07\u20131.17, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). CXR scores were also independently associated with both ICU length of stay (rate ratio 1.06, CI 1.04\u20131.07, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and duration of mechanical ventilation (rate ratio 1.05, CI 1.02\u20131.07, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Higher values on a simple visual score of a patient\u2019s CXR on admission to the medical ICU are associated with increased in-hospital mortality, 60-day mortality, overall mortality, length of ICU stay, and duration of mechanical ventilation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12931-019-1201-0","type":"journal-article","created":{"date-parts":[[2019,10,12]],"date-time":"2019-10-12T07:38:14Z","timestamp":1570865894000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Semi-quantitative visual assessment of chest radiography is associated with clinical outcomes in critically ill patients"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7649-9026","authenticated-orcid":false,"given":"Stefanie E.","family":"Mason","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul B.","family":"Dieffenbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua A.","family":"Englert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela A.","family":"Rogers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony F.","family":"Massaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Fredenburgh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica","family":"Higuera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayra","family":"Pinilla-Vera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Vilas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"San Jose Estepar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R.","family":"Washko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M.","family":"Baron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Y.","family":"Ash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,10,12]]},"reference":[{"issue":"1","key":"1201_CR1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/CCM.0b013e3181b090d0","volume":"38","author":"NA Halpern","year":"2010","unstructured":"Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010;38(1):65\u201371.","journal-title":"Crit Care Med"},{"issue":"5","key":"1201_CR2","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1097\/01.CCM.0000215112.84523.F0","volume":"34","author":"JE Zimmerman","year":"2006","unstructured":"Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute physiology and chronic health evaluation (APACHE) IV: hospital mortality assessment for today's critically ill patients. Crit Care Med. 2006;34(5):1297\u2013310.","journal-title":"Crit Care Med"},{"issue":"6","key":"1201_CR3","doi-asserted-by":"publisher","first-page":"R161","DOI":"10.1186\/cc7160","volume":"12","author":"L Minne","year":"2008","unstructured":"Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review. Crit Care. 2008;12(6):R161.","journal-title":"Crit Care"},{"issue":"1","key":"1201_CR4","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1378\/chest.11-0330","volume":"141","author":"MJ Breslow","year":"2012","unstructured":"Breslow MJ, Badawi O. Severity scoring in the critically ill: part 1--interpretation and accuracy of outcome prediction scoring systems. Chest. 2012;141(1):245\u201352.","journal-title":"Chest"},{"issue":"1","key":"1201_CR5","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/CCM.0b013e3181f96f81","volume":"39","author":"MT Keegan","year":"2011","unstructured":"Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med. 2011;39(1):163\u20139.","journal-title":"Crit Care Med"},{"issue":"2","key":"1201_CR6","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1177\/0951484817696212","volume":"30","author":"A Awad","year":"2017","unstructured":"Awad A, Bader-El-Den M, McNicholas J. Patient length of stay and mortality prediction: a survey. Health Serv Manag Res. 2017;30(2):105\u201320.","journal-title":"Health Serv Manag Res"},{"issue":"1","key":"1201_CR7","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/S2213-2600(14)70239-5","volume":"3","author":"R Pirracchio","year":"2015","unstructured":"Pirracchio R, Petersen ML, Carone M, Rigon MR, Chevret S, van der Laan MJ. Mortality prediction in intensive care units with the super ICU learner algorithm (SICULA): a population-based study. Lancet Respir Med. 2015;3(1):42\u201352.","journal-title":"Lancet Respir Med"},{"key":"1201_CR8","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.ijmedinf.2017.10.002","volume":"108","author":"A Awad","year":"2017","unstructured":"Awad A, Bader-El-Den M, McNicholas J, Briggs J. Early hospital mortality prediction of intensive care unit patients using an ensemble learning approach. Int J Med Inform. 2017;108:185\u201395.","journal-title":"Int J Med Inform"},{"issue":"5","key":"1201_CR9","doi-asserted-by":"publisher","first-page":"e0127428","DOI":"10.1371\/journal.pone.0127428","volume":"10","author":"J Lee","year":"2015","unstructured":"Lee J, Maslove DM, Dubin JA. Personalized mortality prediction driven by electronic medical data and a patient similarity metric. PLoS One. 2015;10(5):e0127428.","journal-title":"PLoS One"},{"issue":"4","key":"1201_CR10","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/j.chest.2017.06.050","volume":"152","author":"CM Lilly","year":"2017","unstructured":"Lilly CM, Swami S, Liu X, Riker RR, Badawi O. Five-year trends of critical care practice and outcomes. Chest. 2017;152(4):723\u201335.","journal-title":"Chest"},{"issue":"5","key":"1201_CR11","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1097\/ALN.0000000000001612","volume":"126","author":"JC Orban","year":"2017","unstructured":"Orban JC, Walrave Y, Mongardon N, Allaouchiche B, Argaud L, Aubrun F, et al. Causes and characteristics of death in intensive care units: a prospective multicenter study. Anesthesiology. 2017;126(5):882\u20139.","journal-title":"Anesthesiology"},{"issue":"9","key":"1201_CR12","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1136\/thoraxjnl-2017-211280","volume":"73","author":"MA Warren","year":"2018","unstructured":"Warren MA, Zhao Z, Koyama T, Bastarache JA, Shaver CM, Semler MW, et al. Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS. Thorax. 2018;73(9):840\u20136.","journal-title":"Thorax"},{"issue":"12","key":"1201_CR13","doi-asserted-by":"publisher","first-page":"e1001577","DOI":"10.1371\/journal.pmed.1001577","volume":"10","author":"K Nakahira","year":"2013","unstructured":"Nakahira K, Kyung SY, Rogers AJ, Gazourian L, Youn S, Massaro AF, et al. Circulating mitochondrial DNA in patients in the ICU as a marker of mortality: derivation and validation. PLoS Med. 2013;10(12):e1001577 discussion e.","journal-title":"PLoS Med"},{"issue":"11","key":"1201_CR14","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1164\/rccm.201201-0003OC","volume":"185","author":"T Dolinay","year":"2012","unstructured":"Dolinay T, Kim YS, Howrylak J, Hunninghake GM, An CH, Fredenburgh L, et al. Inflammasome-regulated cytokines are critical mediators of acute lung injury. Am J Respir Crit Care Med. 2012;185(11):1225\u201334.","journal-title":"Am J Respir Crit Care Med"},{"issue":"8","key":"1201_CR15","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","volume":"315","author":"M Singer","year":"2016","unstructured":"Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801\u201310.","journal-title":"JAMA"},{"issue":"23","key":"1201_CR16","first-page":"2526","volume":"307","author":"ADT Force","year":"2012","unstructured":"Force ADT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526\u201333.","journal-title":"JAMA"},{"issue":"1","key":"1201_CR17","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1093\/biomet\/69.1.239","volume":"69","author":"D Schoenfeld","year":"1982","unstructured":"Schoenfeld D. Partial residuals for the proportional hazards regression model. Biometrika. 1982;69(1):239\u201341.","journal-title":"Biometrika"},{"issue":"3","key":"1201_CR18","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","volume":"44","author":"ER DeLong","year":"1988","unstructured":"DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837\u201345.","journal-title":"Biometrics"},{"issue":"2","key":"1201_CR19","first-page":"260","volume":"18","author":"G Heller","year":"2017","unstructured":"Heller G, Seshan VE, Moskowitz CS, Gonen M. Inference for the difference in the area under the ROC curve derived from nested binary regression models. Biostatistics. 2017;18(2):260\u201374.","journal-title":"Biostatistics"},{"issue":"6","key":"1201_CR20","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1002\/ppul.10280","volume":"35","author":"S Terheggen-Lagro","year":"2003","unstructured":"Terheggen-Lagro S, Truijens N, van Poppel N, Gulmans V, van der Laag J, van der Ent C. Correlation of six different cystic fibrosis chest radiograph scoring systems with clinical parameters. Pediatr Pulmonol. 2003;35(6):441\u20135.","journal-title":"Pediatr Pulmonol"},{"issue":"10","key":"1201_CR21","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1136\/thx.2010.136242","volume":"65","author":"AP Ralph","year":"2010","unstructured":"Ralph AP, Ardian M, Wiguna A, Maguire GP, Becker NG, Drogumuller G, et al. A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis. Thorax. 2010;65(10):863\u20139.","journal-title":"Thorax"},{"key":"1201_CR22","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12880-015-0103-y","volume":"15","author":"E Taylor","year":"2015","unstructured":"Taylor E, Haven K, Reed P, Bissielo A, Harvey D, McArthur C, et al. A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study. BMC Med Imaging. 2015;15:61.","journal-title":"BMC Med Imaging"},{"issue":"3","key":"1201_CR23","doi-asserted-by":"publisher","first-page":"734","DOI":"10.2214\/ajr.184.3.01840734","volume":"184","author":"GE Antonio","year":"2005","unstructured":"Antonio GE, Wong KT, Tsui EL, Chan DP, Hui DS, Ng AW, et al. Chest radiograph scores as potential prognostic indicators in severe acute respiratory syndrome (SARS). AJR Am J Roentgenol. 2005;184(3):734\u201341.","journal-title":"AJR Am J Roentgenol"},{"issue":"24","key":"1201_CR24","doi-asserted-by":"publisher","first-page":"2564","DOI":"10.1056\/NEJMoa062200","volume":"354","author":"L National Heart","year":"2006","unstructured":"National Heart L. Blood institute acute respiratory distress syndrome clinical trials N, Wiedemann HP, wheeler AP, Bernard GR, Thompson BT, et al. comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564\u201375.","journal-title":"N Engl J Med"},{"issue":"4","key":"1201_CR25","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1097\/00024382-200210000-00002","volume":"18","author":"K Emmanuilidis","year":"2002","unstructured":"Emmanuilidis K, Weighardt H, Matevossian E, Heidecke CD, Ulm K, Bartels H, et al. Differential regulation of systemic IL-18 and IL-12 release during postoperative sepsis: high serum IL-18 as an early predictive indicator of lethal outcome. Shock. 2002;18(4):301\u20135.","journal-title":"Shock"},{"issue":"6","key":"1201_CR26","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1097\/00024382-200116060-00001","volume":"16","author":"A Oberholzer","year":"2001","unstructured":"Oberholzer A, Steckholzer U, Kurimoto M, Trentz O, Ertel W. Interleukin-18 plasma levels are increased in patients with sepsis compared to severely injured patients. Shock. 2001;16(6):411\u20134.","journal-title":"Shock"},{"issue":"4","key":"1201_CR27","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/MCC.0000000000000427","volume":"23","author":"JS Harrington","year":"2017","unstructured":"Harrington JS, Choi AMK, Nakahira K. Mitochondrial DNA in Sepsis. Curr Opin Crit Care. 2017;23(4):284\u201390.","journal-title":"Curr Opin Crit Care"},{"key":"1201_CR28","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1186\/1479-5876-10-130","volume":"10","author":"CT Kung","year":"2012","unstructured":"Kung CT, Hsiao SY, Tsai TC, Su CM, Chang WN, Huang CR, et al. Plasma nuclear and mitochondrial DNA levels as predictors of outcome in severe sepsis patients in the emergency room. J Transl Med. 2012;10:130.","journal-title":"J Transl Med"},{"issue":"1","key":"1201_CR29","doi-asserted-by":"publisher","first-page":"R15","DOI":"10.1186\/cc8872","volume":"14","author":"C Pierrakos","year":"2010","unstructured":"Pierrakos C, Vincent JL. Sepsis biomarkers: a review. Crit Care. 2010;14(1):R15.","journal-title":"Crit Care"}],"container-title":["Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-019-1201-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12931-019-1201-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-019-1201-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,10]],"date-time":"2020-10-10T23:10:22Z","timestamp":1602371422000},"score":1,"resource":{"primary":{"URL":"https:\/\/respiratory-research.biomedcentral.com\/articles\/10.1186\/s12931-019-1201-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,12]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["1201"],"URL":"https:\/\/doi.org\/10.1186\/s12931-019-1201-0","relation":{},"ISSN":["1465-993X"],"issn-type":[{"value":"1465-993X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,12]]},"assertion":[{"value":"17 July 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All patients, or their surrogates, provide written informed consent and the study is approved by the Partner\u2019s Institutional Review Board (No. 2008P000495).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"218"}}