Diagnostic and prognostic value of an integrated assessment of clinical parameters, laboratory biomarkers and quantitative CT histogram analysis of adrenal gland attenuation:A prospective single-center cohort study in patients with suspected septic condit

简介：脓毒症患者的治疗和临床过程往往是长期的和昂贵的，同时具有50%的高发病率和死亡率。最好的治疗选择是早期诊断和准确评估脓毒症的严重程度。老年、免疫缺陷和重症监护患者发生败血症的风险更高。他们的人数稳步上升。迄今为止，脓毒症、严重脓毒症和脓毒性休克主要是临床驱动的诊断，由感染性疾病的实验室检测和通过成像证明感染病灶支持。在临床常规中，通常在该患者组中，对比增强全身计算机断层扫描（CT）是首选的方式。迄今为止，在这些CT研究过程中，尚未系统评估用于评价脓毒症严重程度和以成像生物标志物的方式用于预后目的的定量CT参数，如果是这样，则未在综合方法中与临床参数和实验室检测结果一起进行充分评价。然而，有已发表的证据表明，在对比增强CT中发现所谓的肾上腺超衰减与患有创伤或严重内部病理状况（例如败血症）的重症患者相关。目的：鉴于重症监护领域的医疗发展稳步改善，以及有效但昂贵的药物治疗选择范围不断扩大，迫切需要改善疑似脓毒症患者的诊断和预后评估。因此，应考虑所有跨学科的可用参数。研究方法：由于Hounsfield标度线性，CT中密度值的良好再现性可用于在全身CT扫描的框架中评估疑似脓毒症患者确实进行了评估，以评估额外的定量参数，更具体地说，来自肾上腺的基于密度的直方图数据。利用这些数据，类似于例如实验室生物标志物，这种新开发的成像生物标志物可用于改善该患者队列的诊断、严重程度分级和预后评估（放射组学方法）。观点：因此，该项目的目的是首先在大数据方法中评估每个跨学科测量的定性或定量脓毒症参数的相关性，并在第二步中特别关注成像生物标志物的价值，如果任何单独的CT参数或评估参数的任何组合增加了诊断和/或疑似败血症重症监护患者研究队列的预后评估。

Introduction: The therapy and the clinical course of septic patients is often prolonged and costly with high morbidity and mortality rates of 50% at the same time. The best therapeutic options are in case of early diagnosis and accurate assessment of the severity of the septic condition. Elderly, immune-deficient and intensive care patients have a higher risk of developing a sepsis. Their number rises steadily. Sepsis, severe sepsis and septic shock are to date primarily clinically-driven diagnoses, supported by laboratory testing for infectious condition and proof of an infectious focus by means of imaging. In clinical routine, normally in this patient group contrasted-enhanced whole-body computed tomography (CT) is the modality of choice. Quantitative CT parameters used to evaluate the severity of a septic condition and for prognostic purposes in the way of imaging biomarkers are to date not yet systematically assessed in the course of these CT studies and if so, they are not sufficiently evaluated in an integrated approach together with the clinical parameters and laboratory testing results. Yet, there is published evidence that the finding of so-called hyper-attenuating adrenal glands in contrast-enhanced CT is associated with severely ill patients suffering from trauma or severe internal pathologic conditions, e.g. sepsis. Aims: In the light of steadily improving medical developments in the field of intensive care and the growing range of potent but costly pharmacologic treatment options there is a pressing socio-economic need to improve diagnosis and prognostic evaluation of patients with suspected sepsis. Therefore, all interdisciplinary available parameters should be taken into consideration. Methods: The good reproducibility of density values in CT due to Hounsfield-scale linearity could be used to assess in the framework of the whole body CT scans patients with suspected sepsis do undergo to assess additional quantitative parameters, more specifically density-based histogram data from the adrenal glands. With these data, in analogy to e.g. laboratory biomarkers, this newly-developed imaging biomarkers could be used to improve diagnosis, severity grading, and prognostic evaluation of this patient cohort (Radiomics approach). Perspectives: The aim of this project is therefore to firstly assess in a big data approach the relevance of each and every single interdisciplinary measured qualitative or quantitative sepsis parameter and to evaluate in a second step with a special radiological focus on the value of imaging biomarkers if any CT parameter alone or any combination of the assessed parameters adds to diagnosis and/or prognostic assessment in the study cohort of intensive care patients with suspected sepsis.