Department of Pediatric Pulmonology, Erasmus Medical Center (MC)-Sophia Children’s Hospital, Rotterdam, The Netherlands.
Am J Respir Crit Care Med. 2012 May 15;185(10):1096-103. doi: 10.1164/rccm.201111-2065OC. Epub 2012 Mar 8.
Up to one-third of patients with cystic fibrosis (CF) awaiting lung transplantation (LTX) die while waiting. Inclusion of computed tomography (CT) scores may improve survival prediction models such as the lung allocation score (LAS).
This study investigated the association between CT and survival in patients with CF screened for LTX.
Clinical data and chest CTs of 411 patients with CF screened for LTX between 1990 and 2005 were collected from 17 centers. CTs were scored with the Severe Advanced Lung Disease (SALD) four-category scoring system, including the components infection/inflammation (INF), air trapping/hypoperfusion (AT), normal/hyperperfusion (NOR), and bulla/cysts (BUL). The volume of each component was computed using semiautomated software. Survival analysis included Kaplan-Meier curves and Cox regression models.
Three hundred and sixty-six (186 males) of 411 patients entered the waiting list (median age, 23 yr; range, 5-58 yr). Subsequently, 67 of 366 (18%) died while waiting, 263 of 366 (72%) underwent LTX, and 36 of 366 (10%) were awaiting LTX at the census date. INF and LAS were significantly associated with waiting list mortality in univariate analyses. The multivariate Cox model including INF and LAS grouped in tertiles, and comparing tertiles 2 and 3 with tertile 1, showed waiting list mortality hazard ratios of 1.62 (95% confidence interval [95% CI], 0.78-3.36; P = 0.19) and 2.65 (95% CI, 1.35-5.20; P = 0.005) for INF, and 1.42 (95% CI, 0.63-3.24; P = 0.40), and 2.32 (95% CI, 1.17-4.60; P = 0.016) for LAS, respectively. These results indicated that INF and LAS had significant, independent predictive value for survival.
CT score INF correlates with survival, and adds to the predictive value of LAS.
多达三分之一的囊性纤维化（CF）患者在等待肺移植（LTX）时死亡。纳入计算机断层扫描（CT）评分可能会改善肺分配评分（LAS）等生存预测模型。
本研究旨在探讨 CF 患者接受 LTX 筛查时 CT 与生存之间的关系。
从 17 个中心收集了 1990 年至 2005 年间接受 LTX 筛查的 411 名 CF 患者的临床数据和胸部 CT。使用严重先进肺病（SALD）四分类评分系统对 CT 进行评分，包括感染/炎症（INF）、空气滞留/低灌注（AT）、正常/高灌注（NOR）和大疱/囊肿（BUL）四个组成部分。使用半自动软件计算每个成分的体积。生存分析包括 Kaplan-Meier 曲线和 Cox 回归模型。
411 名患者中有 366 名（186 名男性）进入等候名单（中位年龄 23 岁；范围 5-58 岁）。随后，366 名等候名单患者中有 67 名（18%）在等候期间死亡，366 名患者中有 263 名（72%）接受了 LTX，366 名患者中有 36 名（10%）在普查日等待 LTX。在单变量分析中，INF 和 LAS 与等候名单死亡率显著相关。多变量 Cox 模型包括 INF 和 LAS 分为三组，将第二组和第三组与第一组进行比较，显示 INF 的等候名单死亡率风险比分别为 1.62（95%置信区间[95%CI]，0.78-3.36；P = 0.19）和 2.65（95%CI，1.35-5.20；P = 0.005），LAS 的风险比分别为 1.42（95%CI，0.63-3.24；P = 0.40）和 2.32（95%CI，1.17-4.60；P = 0.016）。这些结果表明，INF 和 LAS 对生存具有显著的、独立的预测价值。
CT 评分 INF 与生存相关，并增加了 LAS 的预测价值。
