Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study.
Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study.
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DOI：
10.1136/bmjopen-2011-000545
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Suga M
中科院分区：
文献类型：
--
作者：
Ichikado K;Muranaka H;Gushima Y;Kotani T;Nader HM;Fujimoto K;Johkoh T;Iwamoto N;Kawamura K;Nagano J;Fukuda K;Hirata N;Yoshinaga T;Ichiyasu H;Tsumura S;Kohrogi H;Kawaguchi A;Yoshioka M;Sakuma T;Suga M
研究早期急性呼吸窘迫综合征（ARDS）患者高分辨率CT（HRCT）扫描上纤维增生性改变的程度是否影响预后、呼吸机依赖性和相关结局。一项前瞻性观察性队列研究。教学医院的重症监护室。85例符合美欧共识会议标准和合格标准的ARDS患者。在诊断当天进行HRCT扫描，并由两名独立观察员进行前瞻性评估，并根据纤维增生的程度分为6种结果。通过先前发表的方法获得总体HRCT评分。主要结局为60天死亡率。次要结局包括无呼吸机天数、无器官衰竭天数、气压伤发生率和呼吸机相关性肺炎发生率。HRCT评分越高，无器官衰竭天数和无呼吸机天数的减少具有统计学意义。多变量考克斯比例风险模型显示，HRCT评分仍然是死亡率的独立风险因素（HR 1.20; 95% CI 1.06 - 1.36; p=0.005）。多变量分析还显示，CT评分对28天内撤机有预测价值 （OR 0.63; 95% CI 0.48 - 0.82; p=0.0006）以及气压伤发生率（OR 1.61; 95% CI 1.08 - 2.38; p=0.018）和呼吸机相关性肺炎发生率（OR 1.46; 95% CI 1.13 - 1.89; p=0.004）。HRCT评分<210分预测60天生存率的敏感性为71%，特异性为72%，预测28天内撤机的敏感性为75%，特异性为76%。 在早期ARDS患者中，通过HRCT评估肺纤维增生可预测死亡率增加，多器官衰竭的易感性增加，包括呼吸机依赖及其相关结局。在诊断急性呼吸窘迫综合征（ARDS）时，高分辨率CT（HRCT）扫描显示的纤维增生程度是否会影响60天和180天的死亡率？诊断ARDS时HRCT扫描上纤维增生的程度是否会影响呼吸机依赖性及其相关结局？诊断ARDS时HRCT扫描上的纤维增生程度是否会影响多器官功能衰竭？HRCT评估早期ARDS患者肺纤维增生可预测死亡率增加。通过HRCT评估早期ARDS患者的肺纤维增生可预测呼吸机依赖性及其相关结局（气压伤、呼吸机相关肺炎）。HRCT评估早期ARDS患者肺纤维增生增加多器官功能衰竭的易感性。CT评分是基于我们先前发表的将HRCT结果与病理学相关联的研究，并已在其他疾病中进行了评估。一家机构的患者数量相对较少。与临床参数或病理结果缺乏相关性。
To examine whether the extent of fibroproliferative changes on high-resolution CT (HRCT) scan influences prognosis, ventilator dependency and the associated outcomes in patients with early acute respiratory distress syndrome (ARDS). A prospective observational cohort study. Intensive care unit in a teaching hospital. 85 patients with ARDS who met American-European Consensus Conference Criteria and eligible criteria. HRCT scans were performed and prospectively evaluated by two independent observers on the day of diagnosis and graded into six findings according to the extent of fibroproliferation. An overall HRCT score was obtained by previously published method. The primary outcome was 60-day mortality. Secondary outcomes included the number of ventilator-free days, organ failure-free days, the incidence of barotraumas and the occurrence of ventilator-associated pneumonia. Higher HRCT scores were associated with statistically significant decreases in organ failure-free days as well as ventilator-free days. Multivariate Cox proportional hazards model showed that the HRCT score remained an independent risk factor for mortality (HR 1.20; 95% CI 1.06 to 1.36; p=0.005). Multivariate analysis also revealed that the CT score had predictive value for ventilator weaning within 28 days (OR 0.63; 95% CI 0.48 to 0.82; p=0.0006) as well as for an incidence of barotraumas (OR 1.61; 95% CI 1.08 to 2.38; p=0.018) and for an occurrence of ventilator-associated pneumonia (OR 1.46; 95% CI 1.13 to 1.89; p=0.004). A HRCT score <210 enabled prediction of 60-day survival with 71% sensitivity and 72% specificity and of ventilator-weaning within 28 days with 75% sensitivity and 76% specificity. Pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality with an increased susceptibility to multiple organ failure, including ventilator dependency and its associated outcomes. Whether the extent of fibroproliferation on high-resolution CT (HRCT) scan at the time of diagnosis of acute respiratory distress syndrome (ARDS) would impact 60-day and 180-day mortality? Whether the extent of fibroproliferation on HRCT scan at the time of diagnosis of ARDS would impact ventilator dependency and its associated outcomes? Whether the extent of fibroproliferation on HRCT scan at the time of diagnosis of ARDS would impact multiple organ failure? Pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality. Pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts ventilator dependency and its associated outcomes (barotraumas, ventilator-associated pneumonia). Pulmonary fibroproliferation assessed by HRCT in patients with early ARDS increases susceptibility to multiple organ failure. The CT score is based on our previous published studies correlating HRCT findings with pathology and has been evaluated in the other diseases. A relatively small number of patients from a single institution. Lack of correlation with either clinical parameters or pathologic findings.
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DOI：
10.1186/cc1450
发表时间：
2002-02
期刊：
Critical care (London, England)
影响因子：
--
作者：
Meduri GU
通讯作者：
Meduri GU
DOI：
10.1164/ajrccm/139.4.877
发表时间：
1989-04-01
期刊：
AMERICAN REVIEW OF RESPIRATORY DISEASE
影响因子：
--
作者：
FAGON, JY;CHASTRE, J;GIBERT, C
通讯作者：
GIBERT, C
DOI：
10.1164/rccm.2106157
发表时间：
2002-06-01
影响因子：
24.7
作者：
Ichikado, K;Suga, M;Ando, M
通讯作者：
Ando, M
影响因子：
19.7
作者：
Ichikado, K;Suga, M;Ando, M
通讯作者：
Ando, M
影响因子：
9.6
作者：
Mukae, Hiroshi;Ishimoto, Hiroshi;Kohno, Shigeru
通讯作者：
Kohno, Shigeru