Winzer Robert, Martin Ron, Kaiser Daniel, Baldus Jan Christian, Hoberück Sebastian, Hoffmann Ralf-Thorsten, Fedders Dieter
Department of Radiology, Dresden University Hospital, Fetscherstr. 74, 01307, Dresden, Germany.
Department of Neuroradiology, Dresden University Hospital, Fetscherstr. 74, 01307, Dresden, Germany.
Abdom Radiol (NY). 2021 May;46(5):2107-2114. doi: 10.1007/s00261-020-02886-9. Epub 2020 Dec 11.
To investigate whether adrenal gland radiodensities alone or set in relation to either the inferior vena cava (IVC) or the spleen can predict hospital mortality in intensive care unit patients.
One hundred thirty-three intensive care patients (90 males, age: 66.3 ± 14.5 years) with an acute clinical deterioration were included in this retrospective analysis. CT attenuation (Hounsfield units) of adrenal glands, IVC, and spleen was evaluated by 2 radiologists separately. Adrenal-to-IVC and adrenal-to-spleen ratios were calculated. Receiver operating characteristic (ROC) analysis, combined with the Matthews correlation coefficient (MCC) as a classifier, was used to assess which parameter is the most suitable for short-term, intermediate-term, and overall mortality prediction. Interrater agreement was assessed using intraclass correlation coefficient (ICC).
The highest discriminative power to distinguish between deceased and survivors was found for the adrenal gland-to-spleen ratio for the 72-h mortality. A threshold of > 1.4 predicted 72-h mortality with a sensitivity of 79.31% and a specificity of 98.08% (area und the curve (AUC) = 0.94; p < 0.0001; MCCs = 0.81). The positive likelihood ratio was 41; the positive predictive value was 92.20%. Adrenal gland-to-spleen ratio was also best suited to predict the 24-h and overall mortality. ICCs of HU measurements in adrenal gland, IVC, and spleen indicated a high interrater agreement (ICC 0.95-0.99).
To conclude, the adrenal-to-spleen ratio in CT in portal venous phase may serve as an imaged-based predictor for short, intermediate, and overall mortality and as reproducible prognostic marker for patient outcome.
探讨单独的肾上腺放射密度或与下腔静脉（IVC）或脾脏相关的肾上腺放射密度是否可预测重症监护病房患者的医院死亡率。
本回顾性分析纳入了133例急性临床病情恶化的重症监护患者（90例男性，年龄：66.3±14.5岁）。由2名放射科医生分别评估肾上腺、IVC和脾脏的CT衰减（亨氏单位）。计算肾上腺与IVC以及肾上腺与脾脏的比值。采用受试者工作特征（ROC）分析，并结合马修斯相关系数（MCC）作为分类器，评估哪个参数最适合预测短期、中期和总体死亡率。使用组内相关系数（ICC）评估评分者间的一致性。
发现肾上腺与脾脏的比值对区分死亡患者和存活患者在72小时死亡率方面具有最高的判别力。阈值>1.4可预测72小时死亡率，敏感性为79.31%，特异性为98.08%（曲线下面积（AUC）=0.94；p<0.0001；MCCs=0.81）。阳性似然比为41；阳性预测值为92.20%。肾上腺与脾脏的比值也最适合预测24小时和总体死亡率。肾上腺、IVC和脾脏的HU测量的ICC表明评分者间具有高度一致性（ICC 0.95 - 0.99）。
总之，门静脉期CT中的肾上腺与脾脏比值可作为基于影像的短期、中期和总体死亡率预测指标，以及患者预后的可重复预后标志物。
