Department of Respiratory Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, China.
Department of Respiratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu, China.
Sci Rep. 2019 Nov 20;9(1):17190. doi: 10.1038/s41598-019-53865-0.
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 β-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.
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）危重症患者的临床和影像学特征，并评估这些因素的预后影响。最终纳入了 160 例严重 ILD 患者，对其临床、影像学和随访资料进行回顾性研究。患者的院内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 上的肺纤维化（OR=2.85，P=0.002）和无创通气（OR=1.86，P=0.037）是影响 ILD 危重症患者生存的有害因素。相反，氧合指数（OR=0.99，P=0.028）、常规氧疗（OR=0.59，P=0.048）和β-内酰胺类抗生素的使用（OR=0.51，P=0.004）是保护因素。在 CT 上有无纤维化的 ILD 患者的生存率存在显著差异（Log-rank，p=0.001）。ILD 危重症患者的预后较差。休克、呼吸衰竭和胸部 CT 纤维化征象影响预后。胸部 CT 被认为是提示预后的有价值的工具。
