Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
BMJ Open Respir Res. 2019 Dec 23;6(1):e000471. doi: 10.1136/bmjresp-2019-000471. eCollection 2019.
Pneumonia is a major cause of mortality and morbidity, but the development of new antimicrobials is lacking. Radiological assessment of pneumonia severity may serve as an effective intermediate endpoint to reduce barriers to successful completion of antimicrobial trials. We sought to determine whether the Radiologic Severity Index (RSI) correlated with mortality and healthcare resource utilisation in patients with acute leukaemia undergoing induction chemotherapy.
We measured RSI (range 0-72) on all chest radiographs performed within 33 days of induction chemotherapy in 165 haematological malignancy patients with pneumonia. Peak RSI was defined as the highest RSI score within 33 days of induction. We used extended Cox proportional hazards models to measure the association of time-varying RSI with all-cause mortality within the first 33 days after induction chemotherapy, and logistic regression or generalised models to measure the association of RSI with total daily cost and healthcare resource utilisation.
After adjustment for clinical variables, each one-point increase in RSI was associated with a 7% increase in all-cause 33-day mortality (HR 1.07, 95% CI 1.05 to 1.09, p<0.0001). Peak RSI values of 37.5 or higher were associated with 86% higher daily direct costs (p<0.0001), more days in intensive care unit (9.9 vs 4.8 days, p=0.001) and higher odds for mechanical ventilation (OR 12.1, p<0.0001).
Greater radiological severity as measured by RSI was associated with increased mortality and morbidity in acute leukaemia patients with pneumonia. RSI is a promising intermediate marker of pneumonia severity and is well suited for use in antimicrobial trials.
肺炎是导致死亡率和发病率的主要原因，但新的抗菌药物的开发却不足。肺炎严重程度的影像学评估可以作为减少成功完成抗菌药物试验障碍的有效中间终点。我们试图确定在接受诱导化疗的急性白血病患者中，放射学严重指数（RSI）是否与死亡率和医疗保健资源利用相关。
我们测量了 165 例患有肺炎的血液恶性肿瘤患者在诱导化疗后 33 天内进行的所有胸部 X 光片的 RSI（范围 0-72）。峰值 RSI 定义为诱导后 33 天内的最高 RSI 评分。我们使用扩展 Cox 比例风险模型来测量时间变化的 RSI 与诱导化疗后 33 天内全因死亡率的关联，使用逻辑回归或广义模型来测量 RSI 与总日费用和医疗保健资源利用的关联。
在校正临床变量后，RSI 每增加 1 分，全因 33 天死亡率增加 7%（HR 1.07，95%CI 1.05 至 1.09，p<0.0001）。RSI 值为 37.5 或更高与每日直接费用增加 86%相关（p<0.0001），重症监护病房住院天数增加（9.9 天 vs 4.8 天，p=0.001），机械通气的可能性更高（OR 12.1，p<0.0001）。
RSI 测量的放射学严重程度与肺炎急性白血病患者的死亡率和发病率增加相关。RSI 是肺炎严重程度的有前途的中间标志物，非常适合用于抗菌药物试验。
