Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany.
Dresden University Hospital, Department of Neuroradiology, Fetscherstr. 74, 01307 Dresden, Germany.
Eur J Radiol. 2021 Oct;143:109939. doi: 10.1016/j.ejrad.2021.109939. Epub 2021 Aug 28.
To investigate the value of contrast-enhanced CT findings - splenic and aortic radiodensities and their ratios (spleno-aortic ratio) - in predicting the prognosis of critical care unit patients (CCU).
One hundred thirteen continuous CCU patients with an acute deterioration (Group A: 37 women, age: 67.2 ± 14.0 years) were included in the retrospective study. Radiodensities of the spleen and aorta were evaluated by two radiologists separately. The spleno-aortic ratio was calculated. Matthews correlation coefficient (MCC) was used in conjunction with receiver operating characteristic analysis (ROC) to assess if and which parameter was most suitable for short-term mortality prediction. The intra-class correlation coefficient assessed consensus across readers. To validate the results for the best predictor, a second cohort was evaluated (Group B: 354 CT scans).
The portal venous spleno-aortic ratio was best suited to predict 72-hour mortality (AUC = 0.91). A threshold ratio ≤0.53 predicted short-term mortality with a high sensitivity (80.95%) and specificity (96.74%, MCC = 0.79). The post-test probability was 85%, assuming a pre-test probability of 18.6% (72-hour mortality rate). ICCs of HU measurements in the aorta, spleen, and its ratios showed high interrater agreement (ICC: 0.92-0.99). In a control cohort, a threshold ratio ≤0.53 predicted CCU patientś outcome satisfactorily (SENS = 83.93%, SPEC = 97.65%, PPV = 87.00%, NPV = 97.00%).
The portal venous spleno-aortic ratio serves as a distinctive imaging feature to predict short-term mortality. For CCU patients with a cut-off portal venous spleno-aortic ratio ≤0.53, the risk of dying within three days after CT scan is approximately twenty times higher.
本研究旨在探讨增强 CT 检查的脾脏和主动脉密度及其比值（脾-主动脉比值）在预测重症监护病房（CCU）患者预后中的价值。
本回顾性研究共纳入 113 例急性恶化的连续 CCU 患者（A 组：37 名女性，年龄：67.2±14.0 岁）。由两位放射科医生分别评估脾脏和主动脉的密度。计算脾-主动脉比值。采用 Matthews 相关系数（MCC）结合受试者工作特征分析（ROC）来评估哪些参数最适合短期死亡率预测。采用组内相关系数评估观察者间的一致性。为了验证最佳预测指标的结果，评估了第二个队列（B 组：354 次 CT 扫描）。
门静脉脾-主动脉比值最适合预测 72 小时死亡率（AUC=0.91）。比值≤0.53 预测短期死亡率的敏感性为 80.95%，特异性为 96.74%，MCC=0.79。假设 72 小时死亡率为 18.6%（A 组），则在预试验概率为 18.6%的情况下，后验概率为 85%。主动脉、脾脏及其比值的 HU 测量 ICC 显示出高度的观察者间一致性（ICC：0.92-0.99）。在对照队列中，比值≤0.53 预测 CCU 患者的预后结果令人满意（SENS=83.93%，SPEC=97.65%，PPV=87.00%，NPV=97.00%）。
门静脉脾-主动脉比值是预测短期死亡率的独特影像学特征。对于 CT 扫描后 3 天内死亡风险的 CCU 患者，比值≤0.53 的患者死亡风险约为 20 倍。
