Acute Middle East Respiratory Syndrome Coronavirus: Temporal Lung Changes Observed on the Chest Radiographs of 55 Patients
Acute Middle East Respiratory Syndrome Coronavirus: Temporal Lung Changes Observed on the Chest Radiographs of 55 Patients
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DOI：
10.2214/ajr.15.14445
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发表时间：
2015-09-01
影响因子：
5
通讯作者：
Larsson, Sven G.
中科院分区：
文献类型：
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作者：
Das, Karuna M.;Lee, Edward Y.;Larsson, Sven G.
OBJECTIVE.本研究的目的是描述急性中东呼吸综合征冠状病毒（MERS-CoV）感染患者的连续胸片上的肺部变化，并将胸片结果和最终结果与感染相同病毒的医护人员（HCW）进行比较。还检查了胸部放射学评分和合并症作为致命结局的指标，以确定其潜在的预后价值。材料和方法。对33例MERS CoV感染患者和22例HCW的胸片进行检查，以确定疾病的放射学特征和放射学恶化和进展的证据。在将每个肺分为三个区域后估计胸部放射学评分。将每次胸部放射学检查的所有六个区域的评分（1 [轻度]至4 [重度]）相加，以提供累积胸部放射学评分（范围，0-24）。还检查了系列X线片，以评估从1型（轻度）到4型（重度）疾病的放射学恶化和进展。采用多变量logistic回归分析、Kaplan-Meier生存曲线分析和Mann-Whitney U检验比较死亡患者和恢复患者的数据，以确定预后的放射学特征。毛玻璃样阴影是最常见的异常（66%），其次是实变（18%）。总死亡率为35%（19/55）。患者组的死亡率（55%，18/33）高于HCW组（5%，1/22）。死亡患者的平均胸部放射学评分显著高于康复患者（分别为13 +/- 2.6 [SD] vs 5.8 +/- 5.6; p = 0.001）;此外，（死亡患者vs恢复患者，47% vs 0%; p = 0.001），胸腔积液（63% vs 14%; p = 0.001），4型放射学进展（63% vs 6%; p = 0.001）在死亡患者中观察到。单变量和逻辑回归分析确定胸部放射学评分是死亡率的独立预测因子（比值比[OR]，1.38; 95%CI，1.07-1.77; p = 0.01）。患者组（n = 33）的合并症数量显著高于HCW组（n = 22）（合并症的平均数量分别为1.90 +/- 1.27 vs 0.17 +/- 0.65; p = 0.001）。Kaplan-Meier分析显示中位生存期为15天（95%CI，4-26天）。在胸片上发现的最常见的异常是外周部位的毛玻璃样阴影。较高的胸部放射学评分加上大量的医学合并症与MERS-CoV感染者的预后不良和死亡率较高相关。较少或没有合并症的年轻HCW有较高的存活率。
OBJECTIVE. The objective of our study was to describe lung changes on serial chest radiographs from patients infected with the acute Middle East respiratory syndrome coronavirus (MERS-CoV) and to compare the chest radiographic findings and final outcomes with those of health care workers (HCWs) infected with the same virus. Chest radiographic scores and comorbidities were also examined as indicators of a fatal outcome to determine their potential prognostic value.MATERIALS AND METHODS. Chest radiographs of 33 patients and 22 HCWs infected with MERS-CoV were examined for radiologic features indicative of disease and for evidence of radiographic deterioration and progression. Chest radiographic scores were estimated after dividing each lung into three zones. The scores (1 [mild] to 4 [severe]) for all six zones per chest radiographic examination were summed to provide a cumulative chest radiographic score (range, 0-24). Serial radiographs were also examined to assess for radiographic deterioration and progression from type 1 (mild) to type 4 (severe) disease. Multivariate logistic regression analysis, Kaplan-Meier survival curve analysis, and the Mann-Whitney U test were used to compare data of deceased patients with those of individuals who recovered to identify prognostic radiographic features.RESULTS. Ground-glass opacity was the most common abnormality (66%) followed by consolidation (18%). Overall mortality was 35% (19/55). Mortality was higher in the patient group (55%, 18/33) than in the HCW group (5%, 1/22). The mean chest radiographic score for deceased patients was significantly higher than that for those who recovered (13 +/- 2.6 [SD] vs 5.8 +/- 5.6, respectively; p = 0.001); in addition, higher rates of pneumothorax (deceased patients vs patients who recovered, 47% vs 0%; p = 0.001), pleural effusion (63% vs 14%; p = 0.001), and type 4 radiographic progression (63% vs 6%; p = 0.001) were seen in the deceased patients compared with those who recovered. Univariate and logistic regression analyses identified the chest radiographic score as an independent predictor of mortality (odds ratio [OR], 1.38; 95% CI, 1.07-1.77; p = 0.01). The number of comorbidities in the patient group (n = 33) was significantly higher than that in the HCW group (n = 22) (mean number of comorbidities, 1.90 +/- 1.27 vs 0.17 +/- 0.65, respectively; p = 0.001). The Kaplan-Meier analysis revealed a median survival time of 15 days (95% CI, 4-26 days).CONCLUSION. Ground-glass opacity in a peripheral location was the most common abnormality noted on chest radiographs. A higher chest radiographic score coupled with a high number of medical comorbidities was associated with a poor prognosis and higher mortality in those infected with MERS-CoV. Younger HCWs with few or no comorbidities had a higher survival rate.