Diagnostic and prognostic value of an integrated assessment of clinical parameters, laboratory biomarkers and quantitative CT histogram analysis of adrenal gland attenuation:A prospective single-center cohort study in patients with suspected septic condit

临床参数、实验室生物标志物和肾上腺衰减定量 CT 直方图分析综合评估的诊断和预后价值：一项针对疑似脓毒症患者的前瞻性单中心队列研究

• 批准号: 314834869
• 负责人: Dr. Sonja Janssen
• 金额: --
• 依托单位: Institut für Klinische Radiologie und Nuklearmedizin
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2016
• 资助国家: 德国
• 起止时间: 2015-12-31 至 2018-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/314834869?language=en
• 关键词: Diagnostic; prognostic; value; integrated; assessment

Introduction: The therapy and the clinical course of septic patients is often prolonged and costly with high morbidity and mortality rates of 50% at the same time. The best therapeutic options are in case of early diagnosis and accurate assessment of the severity of the septic condition. Elderly, immune-deficient and intensive care patients have a higher risk of developing a sepsis. Their number rises steadily. Sepsis, severe sepsis and septic shock are to date primarily clinically-driven diagnoses, supported by laboratory testing for infectious condition and proof of an infectious focus by means of imaging. In clinical routine, normally in this patient group contrasted-enhanced whole-body computed tomography (CT) is the modality of choice. Quantitative CT parameters used to evaluate the severity of a septic condition and for prognostic purposes in the way of imaging biomarkers are to date not yet systematically assessed in the course of these CT studies and if so, they are not sufficiently evaluated in an integrated approach together with the clinical parameters and laboratory testing results. Yet, there is published evidence that the finding of so-called hyper-attenuating adrenal glands in contrast-enhanced CT is associated with severely ill patients suffering from trauma or severe internal pathologic conditions, e.g. sepsis. Aims: In the light of steadily improving medical developments in the field of intensive care and the growing range of potent but costly pharmacologic treatment options there is a pressing socio-economic need to improve diagnosis and prognostic evaluation of patients with suspected sepsis. Therefore, all interdisciplinary available parameters should be taken into consideration. Methods: The good reproducibility of density values in CT due to Hounsfield-scale linearity could be used to assess in the framework of the whole body CT scans patients with suspected sepsis do undergo to assess additional quantitative parameters, more specifically density-based histogram data from the adrenal glands. With these data, in analogy to e.g. laboratory biomarkers, this newly-developed imaging biomarkers could be used to improve diagnosis, severity grading, and prognostic evaluation of this patient cohort (Radiomics approach). Perspectives: The aim of this project is therefore to firstly assess in a big data approach the relevance of each and every single interdisciplinary measured qualitative or quantitative sepsis parameter and to evaluate in a second step with a special radiological focus on the value of imaging biomarkers if any CT parameter alone or any combination of the assessed parameters adds to diagnosis and/or prognostic assessment in the study cohort of intensive care patients with suspected sepsis.

简介：脓毒症患者的治疗和临床病程往往漫长且昂贵，同时发病率和死亡率高达 50%。最好的治疗选择是早期诊断和准确评估脓毒症的严重程度。老年人、免疫缺陷者和重症监护患者患败血症的风险较高。他们的数量稳步上升。迄今为止，败血症、严重败血症和败血性休克主要是临床驱动的诊断，并得到感染状况实验室检测和通过影像学证明感染灶的支持。在临床常规中，该患者组通常选择对比增强全身计算机断层扫描（CT）。用于评估脓毒症严重程度和以成像生物标志物的方式进行预后目的的定量 CT 参数迄今为止尚未在这些 CT 研究过程中进行系统评估，即使是这样，也没有通过综合方法对它们进行充分评估结合临床参数和实验室检测结果。然而，有已发表的证据表明，在对比增强 CT 中发现所谓的高衰减肾上腺与患有外伤或严重内部病理状况的重症患者有关，例如，患有严重内科疾病的患者。败血症。目的：鉴于重症监护领域医疗发展的稳步改善以及有效但昂贵的药物治疗选择的范围不断扩大，迫切需要改善疑似脓毒症患者的诊断和预后评估。因此，应考虑所有跨学科可用参数。方法：由于亨斯菲尔德尺度线性，CT 密度值具有良好的可重复性，可用于在全身 CT 扫描的框架内评估疑似脓毒症患者确实接受的其他定量参数，更具体地说，基于密度的直方图数据肾上腺。有了这些数据，类似于例如实验室生物标志物，这种新开发的成像生物标志物可用于改善该患者队列的诊断、严重程度分级和预后评估（放射组学方法）。观点：因此，该项目的目的是首先通过大数据方法评估每个跨学科测量的定性或定量败血症参数的相关性，并在第二步中评估，特别是放射学重点关注成像生物标志物的价值，如果任何单独的 CT 参数或评估参数的任何组合都可以增加疑似脓毒症重症监护患者研究队列的诊断和/或预后评估。