Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany.
Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Emerg Radiol. 2022 Dec;29(6):979-985. doi: 10.1007/s10140-022-02083-9. Epub 2022 Aug 4.
Sepsis is a life-threatening condition that requires immediate focus identification and control. However, international sepsis guidelines do not provide information on imaging choice.
To identify predictors of CT findings and patient outcomes in a population of septic patients from a medical ICU.
A full-text search in the radiological information system (RIS) retrieved 227 body CT examinations conducted to identify infectious sources in 2018. CT reports were categorized according to identified foci and their diagnostic certainty. Diagnostic accuracy of CT was compared to microbiological results. Clinical and laboratory information was gathered. Statistical analysis was performed using nonparametric tests and logistic regression analysis.
CT revealed more positive infectious foci 52.4% (n = 191/227) than microbiological tests 39.3% (n = 79/201). There were no significant differences between focus-positive CT scans with regard to positive microbiological testing (p = 0.32). Sequential organ failure assessment (SOFA) scores were slightly but nonsignificantly higher in patients with a focus-positive CT, odds ratio (OR) = 0.999 (95% CI 0.997-1.001) with p = 0.52. Among C-reactive protein (CRP), procalcitonin (PCT), and leukocytes, in focus-positive versus focus-negative CT scans, CRP showed a minor but statistically significant elevation in the group with focus-positive CT scans (OR = 1.004, 95% CI = 1.000-1.007, p = 0.04). No significant association was found for PCT (OR = 1.007, 95% CI = 0.991-1.023; p = 0.40) or leukocytes (OR = 1.003, 95% CI = 0.970-1.038; p = 0.85). In 33.5% (n = 76/227) of cases, the CT findings had at least one therapeutic consequence. In 81.6% (n = 62/76), the CT findings resulted in one consequence, in 14.5% (n = 11/76) in two consequences, and in 3.9% (n = 3/76) in three consequences. There was no significant association between focus-positive CT scans and mortality (p = 0.81).
In this population of septic patients in medical intensive care, microbiological analysis complemented CT findings. Both clinical and laboratory parameters were not predictive of CT findings. While therapeutic consequences of CT findings in this study population underline the role of CT for decision making in septic patients, CT findings do not predict patient outcomes in this retrospective analysis.
脓毒症是一种危及生命的疾病，需要立即确定感染源并加以控制。然而，国际脓毒症指南并未提供有关影像学选择的信息。
确定在重症监护病房脓毒症患者人群中 CT 表现和患者预后的预测因素。
对 2018 年放射信息系统（RIS）中的 227 例全身 CT 检查进行全文检索，以确定感染源。根据识别出的病灶及其诊断确定性对 CT 报告进行分类。将 CT 的诊断准确性与微生物学结果进行比较。收集临床和实验室信息。使用非参数检验和逻辑回归分析进行统计分析。
CT 显示的阳性感染灶（52.4%，n=191/227）多于微生物学检查（39.3%，n=79/201）。阳性 CT 扫描与阳性微生物学检测之间无显著差异（p=0.32）。在 CT 阳性的患者中，序贯器官衰竭评估（SOFA）评分略高，但无统计学意义，优势比（OR）=0.999（95%CI 0.997-1.001），p=0.52。在 C 反应蛋白（CRP）、降钙素原（PCT）和白细胞中，在 CT 阳性与 CT 阴性的患者中，CRP 在 CT 阳性的患者中略高，但具有统计学意义（OR=1.004，95%CI=1.000-1.007，p=0.04）。未发现 PCT（OR=1.007，95%CI=0.991-1.023；p=0.40）或白细胞（OR=1.003，95%CI=0.970-1.038；p=0.85）与 CT 有显著关联。在 33.5%（n=76/227）的病例中，CT 发现至少有一个治疗后果。在 81.6%（n=62/76）的病例中，CT 发现导致一个后果，在 14.5%（n=11/76）的病例中导致两个后果，在 3.9%（n=3/76）的病例中导致三个后果。CT 阳性扫描与死亡率无显著相关性（p=0.81）。
在本重症监护病房脓毒症患者人群中，微生物分析补充了 CT 发现。临床和实验室参数均不能预测 CT 发现。虽然 CT 发现的治疗后果在本研究人群中强调了 CT 在脓毒症患者决策中的作用，但在本回顾性分析中，CT 发现并不能预测患者预后。
