High-resolution computed tomography for the prediction of mortality in acute respiratory distress syndrome: A retrospective cohort study

Abstract

Background and Aims: Acute respiratory distress syndrome (ARDS) demonstrates several image patterns on high-resolution computed tomography (HRCT). The purpose of this study was to investigate the relationship between specific HRCT findings and the prognosis of ARDS. Methods: This was a retrospective cohort study performed in a single hospital in Japan. We categorized HRCT findings into three distribution patterns: diffuse, subpleural sparing, and dorsal patterns. All patterns were assessed at three levels of each lung. Multivariable logistic regression analysis was used to identify parameters associated with in-hospital mortality. Results: A total of 144 patients with ARDS (age: 72 ± 16 years, 112 men) were included in the study. The in-hospital mortality rate was 42% (survivors, n = 83; nonsurvivors, n = 61). Nonsurvivors were significantly older (70 ± 17 vs 76 ± 13, P = 0.01) and had lower serum albumin levels (P = 0.01), more traction bronchiectasis (P = 0.02), and more diffuse pattern (P < 0.001) than survivors. The presence of diffuse patterns was an independent adverse prognostic factor for predicting mortality (odds ratio, 1.32; 95% confidence interval [CI]: 1.08-1.61, P = 0.007). Conclusions: HRCT distribution patterns may predict mortality in ARDS patients.