title: Computed tomography findings from patients with ARDS due to Influenza A (H1N1) virus-associated pneumonia.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively evaluate whether computed tomography (CT) findings have prognostic value for the prediction of mortality and severity of the clinical course in patients presenting with early stage of acute respiratory distress syndrome (ARDS) due to swine-origin influenza A (S-OIV).
  
  
  METHODS
  Chest CT (16-/64-row multidetector CT) of 23 patients (of whom 9 patients died) were retrospectively reviewed by three independent blinded observers. The CT findings were graded on a 3-point scale (1: normal attenuation, 2: ground-glass attenuation, 3: consolidation). The extent of each abnormality was determined by visually estimating the percentage (to the nearest 10%) of the affected lung parenchyma in each zone and multiplied by the CT-score described above.
  
  
  RESULTS
  All patients presented with a mixture of bilateral patchy consolidations and ground glass opacities. Spearman rank correlation in evaluation of the presence and extent of lung abnormalities by the three different observers was good (correlation coefficient, 0.876-0.922; p < 0.001). The overall CT-score in survivors (mean, 96.0 (± 26.2); range, 53-158) was significantly lower than that in non-survivors (mean, 116.2 (± 14.0); range, 101-139). ROC analysis revealed an area under curve of 0.79 (p = 0.021) for the CT score with an optimal cutoff value of a CT-score of 100 for prediction of survival, with a sensitivity of 100% and a specificity of 64% (accuracy, 78%). For this optimal cutoff, Kaplan-Meier estimator showed a significant difference for the survival ratio (p = 0.011).
  
  
  CONCLUSIONS
  In patients with severe ARDS due to S-OIV-infection, the CT-score has a prognostic value in the prediction of mortality.
authors.affiliation: Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany. christian.grieser@charite.de
authors.forename: Christian
authors.initials: C
authors.lastname: Grieser
authors.forename: Anton
authors.initials: A
authors.lastname: Goldmann
authors.forename: Ingo G
authors.initials: IG
authors.lastname: Steffen
authors.forename: Marc
authors.initials: M
authors.lastname: Kastrup
authors.forename: Carmen María Pérez
authors.initials: CM
authors.lastname: Fernández
authors.forename: Ulrike
authors.initials: U
authors.lastname: Engert
authors.forename: Maria
authors.initials: M
authors.lastname: Deja
authors.forename: Christian
authors.initials: C
authors.lastname: Lojewski
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000000981:diagnostic imaging*; D008297:Male; D011024:Pneumonia, Viral / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*