Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany.
Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany.
Clin Imaging. 2021 Feb;70:56-60. doi: 10.1016/j.clinimag.2020.10.033. Epub 2020 Oct 23.
To investigate whether adrenal gland radiodensities alone or compared to the inferior vena cava (IVC) can correctly predict hospital mortality in patients in intensive care.
One hundred thirteen intensive care patients (76 males, age: 67.2 ± 14.0 years) with an acute clinical deterioration were included in this retrospective analysis. For the venous and the arterial phase CT attenuation (Hounsfield units) of adrenal glands and IVC was ROI-based evaluated by two radiologists separately. ROC analysis, combined with the Matthews Correlation Coefficient (MCC) as a classifier, was used to assess whether one of the parameters is suitable for predicting short and medium-term mortality and, if so, which parameter is most appropriate. Interrater agreement was assessed using the intraclass correlation coefficient.
Twenty-one patients (18.6%) died within three days in the ICU. Measurements of the adrenal glands in the portal venous phase yielded the highest discriminative power (=AUC) to distinguish between deceased and survivors. A threshold ratio of >95.5 predicted 72-hour mortality with a sensitivity of 76.19% and a specificity of 92.39% (AUC = 0.84; p < 0.0001). The positive likelihood ratio was 10.1; the positive predictive value was 69%. The predictive power for 24-hour mortality was slightly lower. Venous adrenal-to-IVC ratios and arterial measurements as a whole were substantially less suitable. All intraclass correlation coefficients indicated a high interrater agreement.
In the portal venous phase, hyperattenuating of the adrenal glands on contrast-enhanced CT can predict short and intermediate ICU mortality quite well and may serve as a reproducible prognostic marker for individual patient outcomes.
研究在重症监护患者中，仅通过肾上腺密度或与下腔静脉（IVC）比较，是否可以正确预测住院死亡率。
本回顾性分析纳入了 113 名因急性临床恶化而入住重症监护病房的患者（76 名男性，年龄：67.2±14.0 岁）。由两位放射科医生分别对肾上腺和 IVC 的静脉期和动脉期 CT 衰减（亨氏单位）进行 ROI 评估。使用 ROC 分析，结合 Matthews 相关系数（MCC）作为分类器，评估这些参数中的任何一个是否适合预测短期和中期死亡率，如果是，哪个参数最合适。采用组内相关系数评估观察者间的一致性。
21 名患者（18.6%）在重症监护病房内 3 天内死亡。门静脉期的肾上腺测量值在区分死亡和存活患者方面具有最高的判别能力（=AUC）。阈值比>95.5 预测 72 小时死亡率的敏感性为 76.19%，特异性为 92.39%（AUC=0.84；p<0.0001）。阳性似然比为 10.1；阳性预测值为 69%。预测 24 小时死亡率的能力略低。静脉肾上腺与 IVC 比值和整体动脉测量值的预测能力明显较低。所有组内相关系数均表明观察者间的一致性很高。
在门静脉期，增强 CT 上肾上腺的高强化可以很好地预测重症监护病房短期和中期死亡率，并可能作为个体患者预后的一种可重复的预后标志物。
