Joussellin Vincent, Meneyrol Eric, Lederlin Mathieu, Jouneau Stéphane, Terzi Nicolas, Tadié Jean-Marc, Gacouin Arnaud
CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France.
CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France.
Respir Med Res. 2024 Nov;86:101140. doi: 10.1016/j.resmer.2024.101140. Epub 2024 Oct 1.
Clinical course prediction of patients with interstitial lung disease (ILD) admitted to the intensive care unit (ICU) for acute respiratory failure (ARF) can be challenging. This study aimed to characterize the prognostic value of admission chest CT-scan in this situation.
We retrospectively included ILD patients admitted to a French ICU for acute respiratory failure requiring oxygen. Patients with lymphangitis carcinomatosis and ANCA vasculitis were excluded. We analyzed every admission chest CT-scan using two different approaches: a visual analysis (grading the extent of traction bronchiectasis, ground glass and honeycomb) and an automated analysis (grading the extent of ground glass and consolidation with a dedicated software). The primary outcome was ICU mortality.
Between January 2014 and October 2020, 81 patients presented an acute respiratory failure with ILD on the admission chest CT-scan. In univariate analysis, only the main pulmonary artery diameter differed between patients who survived and those who died in ICU (30 vs 32 mm, p = 0.021). In multivariate analysis, none of the radiological funding was associated with ICU mortality. Visual and automated analyses did not yield different results, with a strong correlation between the two methods. However, the identification of an UIP pattern (and the presence of honeycomb) was associated with a poorer response to corticosteroid therapy.
Our study showed that the extent of radiological findings and the severity of fibrosis indices on admission chest CT scans of ILD patients admitted to the ICU for ARF were not associated with subsequent deterioration.
对于因急性呼吸衰竭（ARF）入住重症监护病房（ICU）的间质性肺疾病（ILD）患者，临床病程预测可能具有挑战性。本研究旨在描述在这种情况下入院胸部CT扫描的预后价值。
我们回顾性纳入了因急性呼吸衰竭需要吸氧而入住法国ICU的ILD患者。排除癌性淋巴管炎和抗中性粒细胞胞浆抗体血管炎患者。我们使用两种不同方法分析每次入院胸部CT扫描：视觉分析（对牵拉性支气管扩张、磨玻璃影和蜂窝状影的范围进行分级）和自动分析（使用专用软件对磨玻璃影和实变的范围进行分级）。主要结局是ICU死亡率。
2014年1月至2020年10月期间，81例患者入院胸部CT扫描显示急性呼吸衰竭合并ILD。在单因素分析中，存活患者和在ICU死亡患者之间仅主肺动脉直径存在差异（30 vs 32 mm，p = 0.021）。在多因素分析中，没有一项影像学指标与ICU死亡率相关。视觉分析和自动分析结果无差异，两种方法之间具有很强的相关性。然而，UIP模式（以及蜂窝状影的存在）的识别与对皮质类固醇治疗的反应较差相关。
我们的研究表明，因ARF入住ICU的ILD患者入院胸部CT扫描的影像学表现范围和纤维化指数严重程度与随后的病情恶化无关。
