Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases.
OBJECTIVE
To retrospectively evaluate whether the thin-section computed tomographic (CT) appearance has prognostic value for prediction of mortality, number of ventilator-free days (ie, days without mechanical ventilation), and 28-day risk of barotrauma in patients with a clinically early stage of acute respiratory distress syndrome (ARDS) from diverse causes.


METHODS
Institutional review board approval and informed consent were obtained. Two independent observers who were blinded to patient outcomes retrospectively evaluated the thin-section CT scans obtained within 7 days after clinical ARDS onset in 26 survivors and 18 nonsurvivors. Of 44 patients, there were 37 men and seven women (mean age +/- standard deviation, 61.8 years +/- 15.6). CT findings were graded on a scale of 1-6 that corresponded with consecutive pathologic phases: score of 1, normal attenuation; score of 2, ground-glass attenuation; score of 3, consolidation; score of 4, ground-glass attenuation associated with traction bronchiolectasis or bronchiectasis; score of 5, consolidation associated with traction bronchiolectasis or bronchiectasis; and score of 6, honeycombing. An overall CT score was obtained by adding the six averaged scores (three zones in each lung). Multivariate regression analysis was used to assess the independent predictive value of the CT score.


RESULTS
The area of increased attenuation associated with traction bronchiolectasis or bronchiectasis (P = .002), as well as the overall CT score (P = .002), was smaller in survivors than in nonsurvivors. Results of multivariate regression analysis revealed that CT score was independently associated with mortality (P = .006). A CT score of less than 230 enabled prediction of survival with 73% sensitivity and 75% specificity and was associated with both a greater number of ventilator-free days (P = .018) and a lower incidence of barotrauma (P = .013) within 28 days after ARDS onset.


CONCLUSIONS
Extensive thin-section CT abnormalities indicative of fibroproliferative changes were independently predictive of poor prognosis in patients with a clinically early stage of ARDS.
Ichikado
Kazuya
K
Dept of Respiratory Medicine, Graduate School of Medical Sciences, Kumamoto Univ, Kumamoto, Japan. k-ichikado@skh.saiseikai.or.jp
Suga
Moritaka
M
Muranaka
Hiroyuki
H
Gushima
Yasuhiro
Y
Miyakawa
Hisako
H
Tsubamoto
Mitsuko
M
Johkoh
Takeshi
T
Hirata
Naomi
N
Yoshinaga
Takeshi
T
Kinoshita
Yoshihiro
Y
Yamashita
Yasuyuki
Y
Sasaki
Yutaka
Y
D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000209:etiology; D012372:ROC Curve; D012044:Regression Analysis; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*