Sequential Organ Failure Assessment Outperforms Quantitative Chest CT Imaging Parameters for Mortality Prediction in COVID-19 ARDS.
Daniel Puhr-WesterheideJakob ReichBastian O SabelWolfgang Gerhard KunzMatthias Philipp FabritiusPaul ReidlerJohannes RübenthalerMichael IngrishDietmar WassilowskyMichael IrlbeckJens RickeEva GresserPublished in: Diagnostics (Basel, Switzerland) (2021)
(1) Background: Respiratory insufficiency with acute respiratory distress syndrome (ARDS) and multi-organ dysfunction leads to high mortality in COVID-19 patients. In times of limited intensive care unit (ICU) resources, chest CTs became an important tool for the assessment of lung involvement and for patient triage despite uncertainties about the predictive diagnostic value. This study evaluated chest CT-based imaging parameters for their potential to predict in-hospital mortality compared to clinical scores. (2) Methods: 89 COVID-19 ICU ARDS patients requiring mechanical ventilation or continuous positive airway pressure mask ventilation were included in this single center retrospective study. AI-based lung injury assessment and measurements indicating pulmonary hypertension (PA-to-AA ratio) on admission CT, oxygenation indices, lung compliance and sequential organ failure assessment (SOFA) scores on ICU admission were assessed for their diagnostic performance to predict in-hospital mortality. (3) Results: CT severity scores and PA-to-AA ratios were not significantly associated with in-hospital mortality, whereas the SOFA score showed a significant association ( p < 0.001). In ROC analysis, the SOFA score resulted in an area under the curve (AUC) for in-hospital mortality of 0.74 (95%-CI 0.63-0.85), whereas CT severity scores (0.53, 95%-CI 0.40-0.67) and PA-to-AA ratios (0.46, 95%-CI 0.34-0.58) did not yield sufficient AUCs. These results were consistent for the subgroup of more critically ill patients with moderate and severe ARDS on admission (oxygenation index <200, n = 53) with an AUC for SOFA score of 0.77 (95%-CI 0.64-0.89), compared to 0.55 (95%-CI 0.39-0.72) for CT severity scores and 0.51 (95%-CI 0.35-0.67) for PA-to-AA ratios. (4) Conclusions: Severe COVID-19 disease is not limited to lung (vessel) injury but leads to a multi-organ involvement. The findings of this study suggest that risk stratification should not solely be based on chest CT parameters but needs to include multi-organ failure assessment for COVID-19 ICU ARDS patients for optimized future patient management and resource allocation.
Keyphrases
- mechanical ventilation
- acute respiratory distress syndrome
- intensive care unit
- image quality
- extracorporeal membrane oxygenation
- dual energy
- sars cov
- coronavirus disease
- computed tomography
- contrast enhanced
- respiratory failure
- emergency department
- end stage renal disease
- high resolution
- pulmonary hypertension
- positive airway pressure
- ejection fraction
- positron emission tomography
- obstructive sleep apnea
- magnetic resonance imaging
- newly diagnosed
- chronic kidney disease
- early onset
- prognostic factors
- oxidative stress
- magnetic resonance
- case report
- type diabetes
- high intensity
- coronary artery disease
- photodynamic therapy
- patient reported outcomes
- data analysis
- blood flow
- risk assessment
- study protocol
- drug induced
- human health
- deep learning
- clinical evaluation