Background

Acute respiratory distress syndrome (ARDS) is a critical disease in the intensive care unit (ICU) with high morbidity and mortality. The accuracy for predicting ARDS patients' outcome with mechanical ventilation is limited, and most based on clinical information.

Methods

The patients diagnosed with ARDS between January 2014 and June 2019 were retrospectively recruited. Radiomics features were extracted from the upper, middle, and lower levels of the lung, and were further analyzed with the primary outcome (28-day mortality after ARDS onset). The univariate and multivariate logistic regression analyses were applied to figure out risk factors. Various predictive models were constructed and compared.

Results

Of 366 ARDS patients recruited in this study, 276 (median age, 64 years [interquartile range, 54–75 years]; 208 male) survive on the Day 28. Among all factors, the APACHE II Score (OR 2.607, 95% CI 1.896–3.584, P < 0.001), the Radiomics_Score of the middle lung (OR 2.230, 95% CI 1.387–3.583, P = 0.01), the Radiomics_Score of the lower lung (OR 1.633, 95% CI 1.143–2.333, P = 0.01) were associated with the 28-day mortality. The clinical_radiomics predictive model (AUC 0.813, 95% CI 0.767–0.850) show the best performance compared with the clinical model (AUC 0.758, 95% CI 0.710–0.802), the radiomics model (AUC 0.692, 95% CI 0.641–0.739) and the various ventilator parameter-based models (highest AUC 0.773, 95% CI 0.726–0.815).

Conclusions

The radiomics features of chest CT images have incremental values in predicting the 28-day mortality in ARDS patients with mechanical ventilation.

中文翻译：

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胸部 CT 图像对急性呼吸窘迫综合征个性化预后模型的附加价值：一项回顾性研究

背景

急性呼吸窘迫综合征（ARDS）是重症监护病房（ICU）的一种危重疾病，具有高发病率和死亡率。预测 ARDS 患者机械通气结果的准确性有限，并且大多数基于临床信息。

方法

回顾性招募了 2014 年 1 月至 2019 年 6 月期间诊断为 ARDS 的患者。从肺的上层、中层和下层提取放射组学特征，并进一步分析主要结果（ARDS 发作后 28 天死亡率）。应用单变量和多变量逻辑回归分析来找出危险因素。构建并比较了各种预测模型。

结果

在本研究中招募的 366 名 ARDS 患者中，276 名（中位年龄，64 岁 [四分位距，54-75 岁]；208 名男性）在第 28 天存活。在所有因素中，APACHE II 评分（OR 2.607，95% CI 1.896–3.584，P  < 0.001），中肺的 Radiomics_Score（OR 2.230，95% CI 1.387–3.583，P  = 0.01），下肺的 Radiomics_Score（OR 1.633，95% CI 1.143–2.333，P  = 0.01) 与 28 天死亡率相关。与临床模型（AUC 0.758，95% CI 0.710-0.802）、放射组学模型（AUC 0.692，95% CI 0.641-0.739）相比，临床放射组学预测模型（AUC 0.813，95% CI 0.767-0.850）显示出最佳性能以及各种基于呼吸机参数的模型（最高 AUC 0.773，95% CI 0.726–0.815）。

结论

胸部 CT 图像的放射组学特征在预测机械通气 ARDS 患者的 28 天死亡率方面具有增量价值。