Neves Yuri C S, Castro-Lima Victor A C, Solla Davi J F, Ogata Vivian S M, Pereira Fernando L, Araujo Jordana M, Ho Yeh-Li, Chammas Maria Cristina
Instituto de Radiologia (InRad), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, Sao Paulo, Brazil 05403-000.
Departamento e Divisão de Moléstias Infecciosas e Parasitárias, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
AJR Am J Roentgenol. 2021 May;216(5):1392-1399. doi: 10.2214/AJR.20.23455. Epub 2021 Mar 11.
Yellow fever is a hemorrhagic disease caused by an arbovirus endemic in South America; outbreaks have occurred in recent years. The purpose of this study was to describe abdominal ultrasound findings in patients with severe yellow fever and correlate them with clinical and laboratory data. A retrospective cohort study was performed between January and April 2018. The subjects were patients admitted to an ICU with polymerase chain reaction-confirmed yellow fever. Bedside sonography was performed within 48 hours of admission. Images were independently analyzed by two board-certified radiologists. Laboratory test samples were collected within 12 hours of image acquisition. Multivariable logistic regression analysis was performed to identify 30-day mortality predictors; < .05 was considered statistically significant. Forty-six patients (40 [87%] men, six [13%] women; mean age, 47.5 ± 15.2 years) were evaluated with bedside sonography. Laboratory tests showed high serum levels of aspartate aminotransferase (5319 U/L), total bilirubin (6.2 mg/dL), and creati-nine (4.3 mg/dL). Twenty-six (56.5%) patients died within 30 days of admission (median time to death, 5 days [interquartile range, 2-9 days]). The most frequent ultrasound findings were gallbladder wall thickening (80.4%), increased renal cortex echogenicity (71.7%), increased liver parenchyma echogenicity (65.2%), perirenal fluid (52.2%), and ascites (30.4%). Increased renal echogenicity was associated with 30-day mortality (84.6% versus 55.0%; = .046) and was an independent predictor of this outcome after multivariate analysis (odds ratio, 10.89; = .048). Reproducible abdominal ultrasound findings in patients with severe yellow fever may be associated with severity of disease and prognosis among patients treated in the ICU.
黄热病是一种由南美洲地方性虫媒病毒引起的出血性疾病；近年来曾有疫情爆发。本研究旨在描述重症黄热病患者的腹部超声检查结果，并将这些结果与临床和实验室数据相关联。2018年1月至4月间开展了一项回顾性队列研究。研究对象为入住重症监护病房（ICU）且经聚合酶链反应确诊为黄热病的患者。入院后48小时内进行床旁超声检查。影像由两名具备专业资格认证的放射科医生独立分析。在获取影像后12小时内采集实验室检测样本。采用多变量逻辑回归分析确定30天死亡率的预测因素；P<0.05被视为具有统计学显著性。46例患者（40例[87%]男性，6例[13%]女性；平均年龄47.5±15.2岁）接受了床旁超声检查。实验室检测显示血清天冬氨酸氨基转移酶（5319 U/L）、总胆红素（6.2 mg/dL）和肌酐（4.3 mg/dL）水平较高。26例（56.5%）患者在入院后30天内死亡（死亡中位时间为5天[四分位间距，2 - 9天]）。最常见的超声检查结果为胆囊壁增厚（80.4%）、肾皮质回声增强（71.7%）、肝实质回声增强（65.2%）、肾周积液（52.2%）和腹水（30.4%）。肾回声增强与30天死亡率相关（84.6%对55.0%；P = 0.046），且经多变量分析后是这一结果的独立预测因素（比值比，10.89；P = 0.048）。重症黄热病患者可重现的腹部超声检查结果可能与在ICU接受治疗的患者的疾病严重程度及预后相关。
