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Computed Tomography Findings in Septic Patients With Acute Respiratory Distress Syndrome: Correlation With Survival and Pulmonary Versus Extrapulmonary Septic Focus

Stelter, Lars MD*; Steffen, Ingo MD*; Pinkernelle, Jens G. MD*; von Dossow-Hanfstingl, Vera MD; Kastrup, Marc MD; Denecke, Timm MD*; Grieser, Christian MD*

Journal of Computer Assisted Tomography: July/August 2013 - Volume 37 - Issue 4 - p 602–609
doi: 10.1097/RCT.0b013e318295d0c8
Thoracic Imaging

Objective: The objective of this study was to evaluate computed tomography (CT) findings in patients with sepsis with unknown inflammatory focus and acute respiratory distress syndrome.

Methods: Acute respiratory distress syndrome findings on CT of 36 patients with sepsis were graded on a 6-point scale, and the percentage of affected lung was estimated. Resulting CT scores were correlated to intensive care scores and survival.

Results: Forty-four percent of the patients died, revealing a significantly higher CT score than survivors (P = 0.01). Survivors showed larger areas of unaffected lung (P < 0.001), whereas patients with fatal outcome had more ground-glass opacities (P = 0.002; sensitivity, 73%; specificity, 57%) and traction bronchiectasis (P = 0.009; sensitivity, 54%; specificity, 68%). Pulmonary findings on CT did not allow discriminating between a pulmonary and extrapulmonary focus. No significant coherence between CT score and intensive care scores could be revealed.

Conclusions: A CT scoring system based on pulmonary findings in patients with sepsis with acute respiratory distress syndrome comprises prognostic implications in terms of the patients’ survival.

From the *Klinik für Radiologie, Charité–Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; †Klinik für Anaesthesiologie, Klinikum der Universität München, Ludwig-Maximilian-Universität München, München; and ‡Klinik für Anästhesiologie mit Schwerpunkt Operative Intensivmedizin, Charité–Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

Received for publication February 5, 2013; accepted April 2, 2013.

Reprints: Lars Stelter, MD, Klinik für Radiologie, Charité–Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany (e-mail: lars.stelter@charite.de).

Drs Stelter and Steffen contributed equally to this work.

All authors disclose no potential conflict of interest.

© 2013 by Lippincott Williams & Wilkins