Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China.
Br J Radiol. 2023 Mar 1;96(1144):20220948. doi: 10.1259/bjr.20220948. Epub 2023 Feb 14.
To evaluate a series of vascular parameters derived from abdominal dual-phase contrast-enhanced CT as predictors of 14-day mortality and AKI within 7 days in septic shock.
144 patients with septic shock and 60 negative cases were included. The vascular parameters from CT were measured and calculated, including aortic density in arterial (Den-A) and venous phase (Den-V), renal vein density in arterial (Den-A) and venous phase (Den-V), and renal vein-to-aortic density ratio in arterial (DenR-A) and venous phase (DenR-V). The parameters were compared between patients and controls, and between patients with different clinical outcomes, and assessed for predictive value of 14-day mortality and AKI within 7 days.
Patients with septic shock presented significantly lower Den-A ( < 0.001) and DenR-A ( = 0.002) levels than the controls. In the septic shock group, patients who died had significantly lower Den-A ( = 0.001) and lower DenR-A ( < 0.001) than those who survived. Patients who developed AKI had significantly lower Den-A ( < 0.001) and DenR-A ( = 0.011) than those who did not. Multivariate analysis suggested DenR-A as an independent predictor of 14-day mortality (OR 0.012; 95% confidence interval [CI]:0.002,0.086; < 0.001) and Den-A as an independent predictor of AKI (OR 0.989;95% CI:0.982,0.997; = 0.006).
In septic shock, significant decreases in Den-A and DenR-A were associated with the onset of AKI and predicted higher 14-day mortality.
The renal vein density and renal vein-aortic density ratio in arterial phase of dual-phase contrast-enhanced CT may serve as good predictors of AKI and mortality in septic shock.
评估腹部双期增强 CT 得出的一系列血管参数，作为预测脓毒性休克 14 天死亡率和 7 天内急性肾损伤（AKI）的指标。
纳入 144 例脓毒性休克患者和 60 例阴性病例。测量并计算 CT 中的血管参数，包括动脉期（Den-A）和静脉期（Den-V）主动脉密度、动脉期（Den-A）和静脉期（Den-V）肾静脉密度以及动脉期（DenR-A）和静脉期（DenR-V）肾静脉与主动脉密度比。比较患者与对照组、不同临床结局患者之间的参数，并评估其对 14 天死亡率和 7 天内 AKI 的预测价值。
脓毒性休克患者的 Den-A（<0.001）和 DenR-A（=0.002）水平显著低于对照组。在脓毒性休克组中，死亡患者的 Den-A（=0.001）和 DenR-A（<0.001）明显低于存活患者。发生 AKI 的患者的 Den-A（<0.001）和 DenR-A（=0.011）明显低于未发生 AKI 的患者。多变量分析表明，DenR-A 是 14 天死亡率的独立预测因子（OR 0.012；95%置信区间 [CI]：0.002，0.086；<0.001），Den-A 是 AKI 的独立预测因子（OR 0.989；95%CI：0.982，0.997；=0.006）。
在脓毒性休克中，Den-A 和 DenR-A 的显著降低与 AKI 的发生相关，并预测了较高的 14 天死亡率。
双期增强 CT 的动脉期肾静脉密度和肾静脉-主动脉密度比可能是预测脓毒性休克 AKI 和死亡率的良好指标。
