Article Text

Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study
  1. Kazuya Ichikado1,
  2. Hiroyuki Muranaka1,
  3. Yasuhiro Gushima1,
  4. Toru Kotani2,
  5. Habashi M Nader3,
  6. Kiminori Fujimoto4,5,
  7. Takeshi Johkoh6,
  8. Norihiro Iwamoto1,
  9. Kodai Kawamura1,
  10. Junji Nagano7,
  11. Koichiro Fukuda7,
  12. Naomi Hirata8,
  13. Takeshi Yoshinaga8,
  14. Hidenori Ichiyasu9,
  15. Shinsuke Tsumura9,
  16. Hirotsugu Kohrogi9,
  17. Atsushi Kawaguchi10,
  18. Masakazu Yoshioka1,
  19. Tsutomu Sakuma11,
  20. Moritaka Suga1
  1. 1Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
  2. 2Department of Anesthesiology and Intensive Care Tokyo Women's Medical University, Tokyo, Japan
  3. 3Multi-trauma Intensive Care Unit, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
  4. 4Department of Radiology, Kurume University School of Medicine, Kurume, Japan
  5. 5Center for Diagnostic Imaging, Kurume University Hospital, Kurume, Fukuoka, Japan
  6. 6Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public Teachers, Hyogo, Japan
  7. 7Pulmonary Division, Kumamoto City Hospital, Kumamoto, Japan
  8. 8Pulmonary Division, Kumamoto Chu-oh Hospital, Tainoshima, Kumamoto, Japan
  9. 9Department of Respiratory Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
  10. 10Biostatistics Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
  11. 11Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
  1. Correspondence to Dr Kazuya Ichikado; ichikado-k-991017{at}lib.bbiq.jp

Abstract

Objectives 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).

Design A prospective observational cohort study.

Setting Intensive care unit in a teaching hospital.

Participants 85 patients with ARDS who met American-European Consensus Conference Criteria and eligible criteria.

Interventions 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.

Primary and secondary outcomes 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.

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Footnotes

  • To cite: Ichikado K, Muranaka H, Gushima Y, et al. Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study. BMJ Open 2012;2:e000545. doi:10.1136/bmjopen-2011-000545

  • Contributors MS takes full responsibility for the integrity of all the data and the accuracy of the data analysis. KI contributed to designing the study, collecting the data, analysing the data and writing the manuscript. HM contributed to collecting data, analysing the data and revising the manuscript. YG contributed to collecting data, analysing the data and revising the manuscript. TK contributed to analysing the data and revising the manuscript. HMN contributed to reanalysing the data and revising the manuscript. KF, TJ, NI, KK, JN, KF, NH, TY, HI, ST, HK, AK, MY and TS contributed to reanalysing the data and revising the manuscript. Other persons contributing to this study: we appreciate Michael A Matthay (Departments of Medicine and Anesthesia, University of California, San Francisco, CA, USA) and Hiroshi Kubo (Department of Geriatric and Respiratory Medicine, Tohoku University School of Medicine, Tohoku University, Sendai City, Miyagi, Japan) for their editorial assistance and also thank Isamu Cho (Pulmonary Division, Kumamoto City Hospital, Kumamoto City, Japan), Tomoki Tanaka (Pulmonary Division, Kumamoto City Hospital, Kumamoto City, Japan), Junichi Maehara (Department of Emergency and Critical Care Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Shigeo Hiroshige (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Makoto Takaki (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Mitsuko Honda (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Naoko Arakawa (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Yuko Yasuda (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Makiko Takeguchi (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Aoi Teruya (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Yoshitomo Eguchi (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Naoki Shingu (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan), Yoshihiko Sakata (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan) and Azusa Katsume (Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan) for their clinical assistance.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Ethics approval This study was approved by an institutional review board of our hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.

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