title: Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study.
abstract: OBJECTIVE
  To examine whether the extent of fibroproliferative changes on high-resolution CT (HRCT) scan influences prognosis, ventilator dependency and the associated outcomes in patients with early acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  A prospective observational cohort study.
  
  
  METHODS
  Intensive care unit in a teaching hospital.
  
  
  METHODS
  85 patients with ARDS who met American-European Consensus Conference Criteria and eligible criteria.
  
  
  METHODS
  HRCT scans were performed and prospectively evaluated by two independent observers on the day of diagnosis and graded into six findings according to the extent of fibroproliferation. An overall HRCT score was obtained by previously published method.
  
  
  METHODS
  The primary outcome was 60-day mortality. Secondary outcomes included the number of ventilator-free days, organ failure-free days, the incidence of barotraumas and the occurrence of ventilator-associated pneumonia.
  
  
  RESULTS
  Higher HRCT scores were associated with statistically significant decreases in organ failure-free days as well as ventilator-free days. Multivariate Cox proportional hazards model showed that the HRCT score remained an independent risk factor for mortality (HR 1.20; 95% CI 1.06 to 1.36; p=0.005). Multivariate analysis also revealed that the CT score had predictive value for ventilator weaning within 28 days (OR 0.63; 95% CI 0.48 to 0.82; p=0.0006) as well as for an incidence of barotraumas (OR 1.61; 95% CI 1.08 to 2.38; p=0.018) and for an occurrence of ventilator-associated pneumonia (OR 1.46; 95% CI 1.13 to 1.89; p=0.004). A HRCT score <210 enabled prediction of 60-day survival with 71% sensitivity and 72% specificity and of ventilator-weaning within 28 days with 75% sensitivity and 76% specificity.
  
  
  CONCLUSIONS
  Pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality with an increased susceptibility to multiple organ failure, including ventilator dependency and its associated outcomes.
authors.affiliation: Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ichikado
authors.forename: Hiroyuki
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authors.lastname: Muranaka
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Gushima
authors.forename: Toru
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authors.lastname: Kotani
authors.forename: Habashi M
authors.initials: HM
authors.lastname: Nader
authors.forename: Kiminori
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Johkoh
authors.forename: Norihiro
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authors.lastname: Iwamoto
authors.forename: Kodai
authors.initials: K
authors.lastname: Kawamura
authors.forename: Junji
authors.initials: J
authors.lastname: Nagano
authors.forename: Koichiro
authors.initials: K
authors.lastname: Fukuda
authors.forename: Naomi
authors.initials: N
authors.lastname: Hirata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshinaga
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ichiyasu
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Tsumura
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kohrogi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawaguchi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yoshioka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sakuma
authors.forename: Moritaka
authors.initials: M
authors.lastname: Suga