BACKGROUND Respiratory pathology is a major driver of mortality in the intensive care unit (ICU), even in the absence of a primary respiratory diagnosis. Prior work has demonstrated that a visual scoring system applied to chest radiographs (CXR) is associated with adverse outcomes in ICU patients with Acute Respiratory Distress Syndrome (ARDS). We hypothesized that a simple, semi-quantitative CXR score would be associated with clinical outcomes for the general ICU population, regardless of underlying diagnosis. METHODS All individuals enrolled in the Registry of Critical Illness at Brigham and Women's Hospital between June 2008 and August 2018 who had a CXR within 24 h of admission were included. Each patient's CXR was assigned an opacification score of 0-4 in each of four quadrants with the total score being the sum of all four quadrants. Multivariable negative binomial, logistic, and Cox regression, adjusted for age, sex, race, immunosuppression, a history of chronic obstructive pulmonary disease, a history of congestive heart failure, and APACHE II scores, were used to assess the total score's association with ICU length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, 60-day mortality, and overall mortality, respectively. RESULTS A total of 560 patients were included. Higher CXR scores were associated with increased mortality; for every one-point increase in score, in-hospital mortality increased 10% (OR 1.10, CI 1.05-1.16, p < 0.001) and 60-day mortality increased by 12% (OR 1.12, CI 1.07-1.17, p < 0.001). CXR scores were also independently associated with both ICU length of stay (rate ratio 1.06, CI 1.04-1.07, p < 0.001) and duration of mechanical ventilation (rate ratio 1.05, CI 1.02-1.07, p < 0.001). CONCLUSIONS Higher values on a simple visual score of a patient's CXR on admission to the medical ICU are associated with increased in-hospital mortality, 60-day mortality, overall mortality, length of ICU stay, and duration of mechanical ventilation.

中文翻译：

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胸部X光片的半定量视觉评估与危重患者的临床结局有关。

背景技术即使在没有初级呼吸系统诊断的情况下，呼吸道病理也是重症监护病房（ICU）死亡率的主要驱动因素。先前的工作表明，应用于ICU急性呼吸窘迫综合征（ARDS）的患者的不良结局与视觉评分系统应用于胸部X光片（CXR）有关。我们假设，简单的，半定量的CXR评分将与一般ICU人群的临床结局相关，而与基础诊断无关。方法纳入所有在2008年6月至2018年8月期间在布莱汉姆妇女医院危重病登记处登记并在入院24小时内患有CXR的个人。每位患者的CXR在四个象限中的每个象限中均被指定为0-4的乳浊度评分，总分是所有四个象限的总和。使用针对年龄，性别，种族，免疫抑制，慢性阻塞性肺疾病史，充血性心力衰竭史和APACHE II评分进行校正的多变量负二项式，对数和Cox回归，以评估总评分与ICU的关联住院时间（LOS），机械通气时间，住院死亡率，60天死亡率和总死亡率。结果共纳入560例患者。较高的CXR分数与死亡率增加相关；得分每升高1点，医院内死亡率就会增加10％（OR 1.10，CI 1.05-1.16，p <0.001），而60天死亡率增加12％（OR 1.12，CI 1.07-1.17，p <0.001） ）。CXR评分也与ICU住院时间长短独立相关（比率1.06，CI 1.04-1.07，p <0。001）和机械通气时间（比率1.05，CI 1.02-1.07，p <0.001）。结论入院ICU时，对患者的CXR进行简单的视觉评分时，其较高的值与住院死亡率，60天死亡率，总死亡率，ICU住院时间和机械通气时间的增加有关。