侵入性通气的COVID-19患者的RALE评分与CT严重程度评分——比较其预后能力的回顾性研究
The RALE Score Versus the CT Severity Score in Invasively Ventilated COVID-19 Patients-A Retrospective Study Comparing Their Prognostic Capacities.
作者信息
Valk Christel M, Zimatore Claudio, Mazzinari Guido, Pierrakos Charalampos, Sivakorn Chaisith, Dechsanga Jutamas, Grasso Salvatore, Beenen Ludo, Bos Lieuwe D J, Paulus Frederique, Schultz Marcus J, Pisani Luigi
机构信息
Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Location 'AMC', 1105 AZ Amsterdam, The Netherlands.
Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124 Bari, Italy.
出版信息
Diagnostics (Basel). 2022 Aug 26;12(9):2072. doi: 10.3390/diagnostics12092072.
BACKGROUND
Quantitative radiological scores for the extent and severity of pulmonary infiltrates based on chest radiography (CXR) and computed tomography (CT) scan are increasingly used in critically ill invasively ventilated patients. This study aimed to determine and compare the prognostic capacity of the Radiographic Assessment of Lung Edema (RALE) score and the chest CT Severity Score (CTSS) in a cohort of invasively ventilated patients with acute respiratory distress syndrome (ARDS) due to COVID-19.
METHODS
Two-center retrospective observational study, including consecutive invasively ventilated COVID-19 patients. Trained scorers calculated the RALE score of first available CXR and the CTSS of the first available CT scan. The primary outcome was ICU mortality; secondary outcomes were duration of ventilation in survivors, length of stay in ICU, and hospital-, 28-, and 90-day mortality. Prognostic accuracy for ICU death was expressed using odds ratios and Area Under the Receiver Operating Characteristic curves (AUROC).
RESULTS
A total of 82 patients were enrolled. The median RALE score (22 [15-37] vs. 26 [20-39]; = 0.34) and the median CTSS (18 [16-21] vs. 21 [18-23]; = 0.022) were both lower in ICU survivors compared to ICU non-survivors, although only the difference in CTSS reached statistical significance. While no association was observed between ICU mortality and RALE score (OR 1.35 [95%CI 0.64-2.84]; = 0.417; AUC 0.50 [0.44-0.56], this was noticed with the CTSS (OR, 2.31 [1.22-4.38]; = 0.010) although with poor prognostic capacity (AUC 0.64 [0.57-0.69]). The correlation between the RALE score and CTSS was weak (r = 0.075; = 0.012).
CONCLUSIONS
Despite poor prognostic capacity, only CTSS was associated with ICU mortality in our cohort of COVID-19 patients.
背景
基于胸部X线摄影（CXR）和计算机断层扫描（CT）扫描的肺部浸润范围和严重程度的定量放射学评分在危重症有创通气患者中越来越常用。本研究旨在确定并比较肺水肿影像学评估（RALE）评分和胸部CT严重程度评分（CTSS）对一组因新型冠状病毒肺炎（COVID-19）导致的急性呼吸窘迫综合征（ARDS）有创通气患者的预后评估能力。
方法
一项两中心回顾性观察性研究，纳入连续的COVID-19有创通气患者。经过培训的评分者计算首次获得的CXR的RALE评分和首次获得的CT扫描的CTSS。主要结局是重症监护病房（ICU）死亡率；次要结局是幸存者的通气时间、在ICU的住院时间以及住院、28天和90天死亡率。使用比值比和受试者工作特征曲线下面积（AUROC）表示ICU死亡的预后准确性。
结果
共纳入82例患者。与ICU非幸存者相比，ICU幸存者的RALE评分中位数（22[15 - 37]对26[20 - 39]；P = 0.34）和CTSS中位数（18[16 - 21]对21[18 - 23]；P = 0.022）均较低，尽管只有CTSS的差异具有统计学意义。虽然未观察到ICU死亡率与RALE评分之间存在关联（比值比1.35[95%置信区间0.64 - 2.84]；P = 0.417；AUC 0.50[0.44 - 0.56]），但CTSS存在这种关联（比值比2.31[1.22 - 4.38]；P = 0.010），尽管预后能力较差（AUC 0.64[0.57 - 0.69]）。RALE评分与CTSS之间的相关性较弱（r = 0.075；P = 0.012）。
结论
尽管预后能力较差，但在我们的COVID-19患者队列中，只有CTSS与ICU死亡率相关。
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