title: Chest CT features are associated with poorer quality of life in acute lung injury survivors.
abstract: OBJECTIVE
  Despite decreasing mortality rates in acute lung injury, studies of long-term physical function in acute lung injury survivors have consistently reported poorer quality of life persisting years into recovery for reasons that are not completely understood. We sought to determine if pulmonary dysfunction is independently associated with functional impairment among acute lung injury survivors and to determine if high-resolution computed tomography could be used to predict its development.
  
  
  METHODS
  Secondary analysis of data from a randomized controlled trial in acute lung injury.
  
  
  METHODS
  ICUs at three academic medical centers.
  
  
  METHODS
  Patients diagnosed with acute lung injury who had high-resolution computed tomography scans performed at 14 and/or 180 days after diagnosis.
  
  
  METHODS
  None.
  
  
  RESULTS
  An objective radiologic scoring system was used to quantify patterns present on chest high-resolution computed tomography obtained at 14 and 180 days in patients with acute lung injury. These scores were correlated in univariable and multivariable analyses with pulmonary function testing and quality of life survey data obtained at 180 days. Eighty-nine patients had evaluable data at day 14, and 47 at 180 days. At 180 days, increased radiologic scores for reticulation were associated with a decreased total lung capacity, forced vital capacity, and diffusing capacity for carbon monoxide (p values all < 0.002). Decrements in quality of life attributable to pulmonary dysfunction were most strongly associated with higher radiologic scores. Additionally, radiologic scores at 14 days independently predicted poorer quality of life at 180 days, accounting for age, severity of illness, pneumonia as the acute lung injury risk factor, and length of time on mechanical ventilation.
  
  
  CONCLUSIONS
  Among survivors of acute lung injury, increasing chest high-resolution computed tomography involvement correlated with restrictive physiology and poorer health-related quality of life, implicating pulmonary dysfunction as a potential contributor to activity limitation in these patients.
authors.affiliation: Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA. ellen.burnham@ucdenver
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Burnham
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hyzy
authors.forename: Robert
authors.initials: R
authors.lastname: Paine
authors.forename: Curtis
authors.initials: C
authors.lastname: Coley
authors.forename: Aine M
authors.initials: AM
authors.lastname: Kelly
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Quint
authors.forename: David
authors.initials: D
authors.lastname: Lynch
authors.forename: William J
authors.initials: WJ
authors.lastname: Janssen
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Standiford
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology; D011653:Pulmonary Diffusing Capacity; D011788:Quality of Life; D017741:Survivors; D014057:Tomography, X-Ray Computed; D014109:Total Lung Capacity; D014797:Vital Capacity