Department of Radiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Department of Cardiology with Intensive Care, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Clin Radiol. 2022 Mar;77(3):203-209. doi: 10.1016/j.crad.2021.10.020. Epub 2021 Dec 3.
To analyse the diagnostic yield of computed tomography (CT) in septic patients from a medical intensive care unit (ICU).
A full-text search of the department's radiological information system (RIS) retrieved 227 body CT examinations undertaken to search for a septic focus in 2018 from medical ICU patients. CT reports were categorised according to the identified foci. Clinical and laboratory information was gathered. Data were analysed statistically using descriptive statistics, diagnostic test quality criteria, binomial tests and chi-square test.
A total of 227 CT examinations from 165 septic patients detected 264 foci, which were distributed as follows: 58.3% (n=154/264) chest, 26.5% (n=70/264) abdomen, 5.3% (n=14/264) genitourinary system, and 9.8% (n=26/264) other body regions. In 15.9% (n=36/227) no focus was identified on CT. Based on CT reports, 37.5% (n=99/264) of foci were graded as certain, 18.9% (n=50/264) as likely, and 15.9% (n=42/264) as possible infectious sources. Septic foci were detected using CT with 75.8% sensitivity (95% confidence interval [CI] 69.6-81.9%) and 59.46% specificity (95% CI 42.9-76.1%). The positive predictive value was 90.6% (95% CI 86-95.2%), with a negative predictive value of 32.4% (95% CI 21-43.8%).
The present results confirm that body CT is a suitable rule-in test for septic patients in medical intensive care, although it cannot reliably rule out a septic focus. Follow-up CT examinations may reveal a septic source in the further course of a patient's hospital stay.
分析来自重症监护病房（ICU）的脓毒症患者计算机断层扫描（CT）的诊断效果。
对该科室放射信息系统（RIS）进行全文检索，检索出 2018 年为在 ICU 中寻找脓毒症病灶而进行的 227 例全身 CT 检查。根据所确定的病灶对 CT 报告进行分类。收集临床和实验室信息。使用描述性统计、诊断测试质量标准、二项式检验和卡方检验进行数据分析。
在 165 例脓毒症患者的 227 次 CT 检查中，共发现 264 个病灶，分布如下：58.3%（n=154/264）胸部，26.5%（n=70/264）腹部，5.3%（n=14/264）泌尿生殖系统，9.8%（n=26/264）其他身体区域。在 15.9%（n=36/227）的 CT 上未发现病灶。根据 CT 报告，37.5%（n=99/264）的病灶被评为确定性，18.9%（n=50/264）为可能性，15.9%（n=42/264）为可能的感染源。CT 检测到的脓毒症病灶的灵敏度为 75.8%（95%置信区间[CI] 69.6-81.9%），特异性为 59.46%（95%CI 42.9-76.1%）。阳性预测值为 90.6%（95%CI 86-95.2%），阴性预测值为 32.4%（95%CI 21-43.8%）。
目前的结果证实，全身 CT 是 ICU 中脓毒症患者的一种合适的诊断性检查方法，尽管它不能可靠地排除脓毒症病灶。在患者住院期间的后续 CT 检查可能会发现新的感染源。
