Computed tomography findings from patients with ARDS due to Influenza A (H1N1) virus-associated pneumonia

Abstract

Purpose: 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).

Materials and 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).

Conclusion: In patients with severe ARDS due to S-OIV-infection, the CT-score has a prognostic value in the prediction of mortality.

Fig. 1

CT of a 47 year old male patient (no survival; CT score of 117) with ground glass opacity mostly in the upper parts (A) and consolidation in the lower parts (B).

Fig. 2

CT score for prediction of survival.

Fig. 3

ROC analysis of the CT score for prediction of survival.

Fig. 4

Kaplan–Meier estimator showed a significant difference for the survival ratio for a CT-Score cut-off of 100.

Fig. 5

CT score of patients with ECMO therapy.

Fig. 6

ROC analysis of the CT score for prediction of ECMO therapy.