Martin Ron, Fedders Dieter, Winzer Robert, Roos Jonas, Isaak Alexander, Luetkens Julian, Thomas Daniel, Kuetting Daniel
Department of Plastic and Hand Surgery, Burn Care Center, BG Klinikum Bergmannstrost Halle, Merseburger Str. 165, 06112 Halle, Germany.
Department of Radiology and Neuroradiology, Chemnitz Hospital, 09116 Chemnitz, Germany.
J Clin Med. 2025 Mar 22;14(7):2180. doi: 10.3390/jcm14072180.
Radiological imaging is crucial in intensive care settings, particularly for the differential diagnosis of fever and sepsis. Computed tomography (CT) is the preferred method for detecting infectious foci in critically ill ICU patients. This study prospectively analyzed non-ECG-gated chest and abdominal CT scans from ICU patients to assess CT's diagnostic utility. Data from prior imaging modalities (CT, radiography, MRI, ultrasound), microbiological assays (blood cultures, bronchoalveolar lavage, urinalysis), and enzymatic profiles (transaminases, pancreatic enzymes) were included. The predictive value of clinical and laboratory parameters was evaluated via correlation analysis. A total of 112 patients were evaluated, with 99 exhibiting 147 inflammatory foci (92 thoracic, 55 abdominal). Definitive diagnoses were made in 58.5% of cases, while 41.5% remained classified as possible. Prior diagnostic procedures identified inflammatory origins in 57.1% of cases. Fewer CT-detected foci were observed in patients with bronchial asthma or type 2 diabetes mellitus ( = 0.049 and = 0.006). CT imaging plays a central role in identifying infectious foci in ICU patients with unexplained syndromes, particularly in the thoracic region. CT scanning is recommended for sepsis management when other diagnostic evidence is lacking. Conditions such as bronchial asthma or diabetes mellitus may prompt earlier suspicion of infectious foci due to elevated inflammatory markers.
放射影像学在重症监护环境中至关重要，尤其是在发热和脓毒症的鉴别诊断方面。计算机断层扫描（CT）是检测重症监护病房（ICU）危重症患者感染灶的首选方法。本研究前瞻性分析了ICU患者的非心电图门控胸部和腹部CT扫描，以评估CT的诊断效用。纳入了先前成像模式（CT、X线摄影、MRI、超声）、微生物检测（血培养、支气管肺泡灌洗、尿液分析）和酶学指标（转氨酶、胰腺酶）的数据。通过相关性分析评估临床和实验室参数的预测价值。共评估了112例患者，其中99例有147个炎症病灶（92个胸部，55个腹部）。58.5%的病例做出了明确诊断，而41.5%仍归类为可能。先前的诊断程序在57.1%的病例中确定了炎症起源。支气管哮喘或2型糖尿病患者中观察到的CT检测到的病灶较少（P = 0.049和P = 0.006）。CT成像在识别患有不明综合征的ICU患者的感染灶方面起着核心作用，尤其是在胸部区域。当缺乏其他诊断证据时，建议进行CT扫描以管理脓毒症。支气管哮喘或糖尿病等疾病可能由于炎症标志物升高而促使更早怀疑感染灶。
