Prognostic effects of clinical and CT imaging features on critically ill patients with interstitial lung disease hospitalized in respiratory intensive care unit
Prognostic effects of clinical and CT imaging features on critically ill patients with interstitial lung disease hospitalized in respiratory intensive care unit
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DOI：
10.1038/s41598-019-53865-0
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发表时间：
2019-11-20
影响因子：
4.6
通讯作者：
Cai, Hourong
中科院分区：
文献类型：
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作者：
Shi, Shenyun;Xiao, Yonglong;Cai, Hourong
本研究旨在评估在呼吸重症监护病房（RICU）治疗的间质性肺疾病（ILD）危重患者的临床和影像学特征，并评估这些因素对预后的影响。共有160名RICU收治的严重ILD患者最终被纳入本研究。回顾性分析其临床、影像学及随访资料。住院死亡率和总死亡率分别为43.1%和63.8%。多因素cox回归分析显示，休克（OR = 2.39, P = 0.004）、CT示肺纤维化（OR = 2.85, P = 0.002）、无创通气（OR = 1.86, P = 0.037）是影响ILD危重患者生存的有害因素。氧合指数（OR = 0.99, P = 0.028）、常规氧疗（OR = 0.59, P = 0.048）和β -内酰胺类抗生素使用（OR = 0.51, P = 0.004）是保护因素。CT显示，有和没有纤维化的ILD患者的生存率有显著差异（Log-rank, p = 0.001）。重症ILD患者预后较差。胸部CT显示休克、呼吸衰竭及纤维化征象影响预后。胸部CT被认为是判断预后的重要工具。
The study aimed to evaluate the clinical and imaging features of critically ill patients with interstitial lung disease (ILD) treated in respiratory intensive care unit (RICU) and assess the prognostic effects of these factors. A total of 160 severe ILD patients admitted to the RICU were finally enrolled in this study. The clinical, imaging and follow-up data of them were studied retrospectively. The in-hospital mortality and total mortality were 43.1% and 63.8% respectively. By multivariate cox regression analysis, shock (OR = 2.39, P = 0.004), pulmonary fibrosis on CT (OR = 2.85, P = 0.002) and non-invasive ventilation (OR = 1.86, P = 0.037) were harmful factors to survivals of critically ill patients with ILD. In contrast, oxygenation index (OR = 0.99, P = 0.028), conventional oxygen therapy (OR = 0.59, P = 0.048) and beta-lactam antibiotics use (OR = 0.51, P = 0.004) were protective factors. There is significant difference of survivals between patients with and without fibrosing ILD on CT (Log-rank, p = 0.001). The prognosis of critically ill patients with ILD was poor. Shock, respiratory failure and fibrosing signs on chest CT affected the prognosis. Chest CT was considered as a valuable tool to indicate the prognosis.