Hui David S C, Wong K T, Antonio Gregory E, Lee Nelson, Wu Alan, Wong Vincent, Lau Winnie, Wu Justin C, Tam L S, Yu L M, Joynt Gavin M, Chung Sydney S C, Ahuja Anil T, Sung Joseph J Y
Department of Diagnostic Radiology and Organ Imaging, The Chinese Univ of Hong Kong, Prince of Wales Hosp, 30-32 Ngan Shing St, Shatin, Hong Kong SAR.
Radiology. 2004 Nov;233(2):579-85. doi: 10.1148/radiol.2332031649. Epub 2004 Sep 16.
To evaluate whether there is a correlation between the clinical outcomes and radiologic features of severe acute respiratory syndrome (SARS).
The clinical, laboratory, and radiologic features of 138 patients with SARS were analyzed. Three radiologists in consensus retrospectively assessed the frontal chest radiographs obtained at presentation and during treatment (n = 2045) for the distribution (each lung was divided into upper, middle, and lower zones) and extent of lung parenchymal abnormality. Clinical end points included intensive care unit (ICU) admission and death.
Thirty-six (26.1%) patients required ICU care, and eight (5.8%) died. The patients who required ICU care and/or died had more extensive consolidation on chest radiographs obtained initially (median percentage of consolidation, 3.30%, with interquartile range [IR] of 1.70%-8.78% vs 1.70% [IR, 0%-3.30%]; P < .001) and on day 7 after fever onset (median percentage of consolidation, 15.00% [IR, 6.48%-28.73%] vs 5.00% [IR, 2.50%-7.50%]; P < .001) than did surviving patients who did not require ICU care. Patients with involvement of more than one lung zone on initial and day 7 chest radiographs were more likely to require ICU care and/or die than were those with involvement of one or fewer zones (P < .001). Patients with bilateral pneumonic changes at presentation were more likely to have an adverse outcome than were those with unilateral pneumonia (P < .001). Involvement of more than one lung zone at baseline chest radiography was an independent predictor of ICU admission and/or death (odds ratio, 3.16; 95% confidence interval: 1.07, 9.32; P = .037) after adjustments for other significant factors (ie, patient age, and baseline neutrophil count and lactate dehydrogenase level).
More extensive airspace disease at presentation is an independent predictor of adverse outcome in patients with SARS.
评估重症急性呼吸综合征（SARS）的临床结局与放射学特征之间是否存在相关性。
分析了138例SARS患者的临床、实验室及放射学特征。三位放射科医生共同回顾性评估了患者就诊时及治疗期间获得的胸部正位X线片（共2045张），以确定肺实质异常的分布情况（每侧肺分为上、中、下三个区域）及范围。临床终点包括入住重症监护病房（ICU）及死亡。
36例（26.1%）患者需要ICU治疗，8例（5.8%）死亡。需要ICU治疗和/或死亡的患者在初始胸部X线片上的实变范围更广（实变中位数百分比为3.30%，四分位间距[IR]为1.70% - 8.78%，而存活且无需ICU治疗的患者为1.70%[IR，0% - 3.30%]；P <.001），在发热开始后第7天的胸部X线片上也是如此（实变中位数百分比为15.00%[IR，6.48% - 28.73%]，而存活且无需ICU治疗的患者为5.00%[IR，2.50% - 7.50%]；P <.001）。初始及第7天胸部X线片上累及多个肺区的患者比累及一个或更少肺区的患者更有可能需要ICU治疗和/或死亡（P <.001）。就诊时出现双侧肺炎改变的患者比单侧肺炎患者更有可能出现不良结局（P <.001）。在对其他重要因素（即患者年龄、基线中性粒细胞计数及乳酸脱氢酶水平）进行调整后，基线胸部X线片上累及多个肺区是入住ICU及/或死亡的独立预测因素（比值比为3.16；95%置信区间：1.07，9.32；P =.037）。
就诊时气腔病变范围更广是SARS患者不良结局的独立预测因素。
