Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery
Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery
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DOI：
10.1007/s00330-018-5946-5
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发表时间：
2019-06-01
影响因子：
5.9
通讯作者：
Lehmkuhl, Lukas
中科院分区：
文献类型：
--
作者：
Foldyna, Borek;Mueller, Martin;Lehmkuhl, Lukas
ObjectivesTo identify CT parameters independently associated with infectious mediastitis after cardiac surgery and to improve discrimination of patients with acute infection from those with normal postoperative changes.MethodsIn this single center，retrospective，observational cohort study，we evaluated thoracic CT scans of poststernotomy cardiac surgery patients.入选标准为临床疑似纵隔炎、CT征象不清（例如，胸骨后肿块），以及随后的深度翻修手术。翻修手术和微生物样本确定纵隔炎状态。总体而言，22个定性和定量CT成像参数进行了评估，并与感染性纵隔炎的单变量和多变量回归模型。判别能力和增量值的CT功能，以现有的临床参数分别由AUC和似然比tests.ResultsOverall 105例（82%的男性; 67.010.3年）进行了CT和深翻修手术。在83/105例（79%）患者中证实了纵隔炎。在现有的临床参数中，只有C-反应蛋白（CRP）与感染性纵隔炎独立相关（多变量比值比（OR）（每标准差）=2.3; p
ObjectivesTo identify CT parameters independently associated with infectious mediastinitis after cardiac surgery and to improve the discrimination of patients with acute infection from those with normal postoperative changes.MethodsIn this single-center, retrospective, observational cohort study, we evaluated thoracic CT scans of poststernotomy cardiac surgery patients. Inclusion criteria were clinically suspected mediastinitis, unclear CT signs (e.g., retrosternal mass), and subsequent deep revision surgery. Revision surgery and microbiological samples determined the mediastinitis status. Overall, 22 qualitative and quantitative CT imaging parameters were assessed and associated with infectious mediastinitis in univariate and multivariate regression models. Discriminative capacity and incremental value of the CT features to available clinical parameters were determined by AUC and likelihood-ratio tests, respectively.ResultsOverall 105 patients (82% men; 67.010.3years) underwent CT and deep revision surgery. Mediastinitis was confirmed in 83/105 (79%) patients. Among available clinical parameters, only C-reactive protein (CRP) was independently associated with infectious mediastinitis (multivariate odds ratio (OR) (per standard deviation) =2.3; p