Imai Ryosuke, Nishimura Naoki, Takahashi Osamu, Tamura Tomohide
Department of Pulmonary Medicine Thoracic Center, St. Luke's International Hospital Tokyo Japan.
Graduate School of Public Health St. Luke's International University Tokyo Japan.
Health Sci Rep. 2021 Oct 8;4(4):e418. doi: 10.1002/hsr2.418. eCollection 2021 Dec.
Acute respiratory distress syndrome ARDS) demonstrates several image patterns on high-resolution computed tomography (HRCT). The purpose of this study was to investigate the relationship between specific HRCT findings and the prognosis of ARDS.
This was a retrospective cohort study performed in a single hospital in Japan. We categorized HRCT findings into three distribution patterns: diffuse, subpleural sparing, and dorsal patterns. All patterns were assessed at three levels of each lung. Multivariable logistic regression analysis was used to identify parameters associated with in-hospital mortality.
A total of 144 patients with ARDS (age: 72 ± 16 years, 112 men) were included in the study. The in-hospital mortality rate was 42% (survivors, n = 83; nonsurvivors, n = 61). Nonsurvivors were significantly older (70 ± 17 vs 76 ± 13, = 0.01) and had lower serum albumin levels ( = 0.01), more traction bronchiectasis ( = 0.02), and more diffuse pattern ( < 0.001) than survivors. The presence of diffuse patterns was an independent adverse prognostic factor for predicting mortality (odds ratio, 1.32; 95% confidence interval [CI]: 1.08-1.61, = 0.007).
HRCT distribution patterns may predict mortality in ARDS patients.
急性呼吸窘迫综合征（ARDS）在高分辨率计算机断层扫描（HRCT）上呈现出多种影像模式。本研究旨在探讨HRCT的特定表现与ARDS预后之间的关系。
这是一项在日本一家医院进行的回顾性队列研究。我们将HRCT表现分为三种分布模式：弥漫性、胸膜下 sparing 和背侧模式。在每侧肺的三个层面评估所有模式。采用多变量逻辑回归分析来确定与院内死亡率相关的参数。
本研究共纳入144例ARDS患者（年龄：72±16岁，男性112例）。院内死亡率为42%（幸存者，n = 83；非幸存者，n = 61）。与幸存者相比，非幸存者年龄显著更大（70±17 vs 76±13，P = 0.01），血清白蛋白水平更低（P = 0.01），牵引性支气管扩张更多（P = 0.02），弥漫性模式更多（P < 0.001）。弥漫性模式的存在是预测死亡率的独立不良预后因素（优势比，1.32；95%置信区间[CI]：1.08 - 1.61，P = 0.007）。
HRCT分布模式可能预测ARDS患者的死亡率。
