Value of abdominal computed tomography (CT) concerning the prognosis in patients with acute respiratory distress syndrome (ARDS)

Abstract

Sir: ARDS occurs in Europe with a current incidence of about 3.5±4.5 cases per 100,000 inhabitants [1]. Patients with ARDS and additional sepsis have a mortality between 77 and 90%. The abdomen has been described as one possible focus [2]. Bell [3] described the role of abdominal CTscanning in the detection of possible foci. Nevertheless reliable data are not yet available about the diagnostic value of pathological findings in abdominal CTscanning in patients with ARDS, concerning their prognosis. In our retrospective study pathological findings could be detected in 75 of 92 patients with ARDS by abdominal CT scanning. Nineteen (11 male and 8 female) of 92 patients with ARDS died during their treatment in the intensive care unit (ICU). Two (10.5%) of these patients died without, and 17 (89.5%) with, pathological findings on abdominal CT scanning. Patients with intraperitoneal infiltrates (n = 15) showed a higher frequency (46.7%) of death. Ten (20.9%) of the patients who died on the ICU had a hepatomegaly (n = 48) and five patients (17.9%) a splenomegaly (n = 28). The cumulative survival rate for patients without abdominal manifestation was 1 after 20 days, 0.94 after 60 days and 0.88 after 100 days. The mean survival rate, calculated by the Kaplan-Meier method, was 65.5 days (Fig.1). The cumulative survival rate for patients with abdominal manifestation was 0.93 after 20 days, 0.8 after 60 days and 0.773 after 100 days. Mean survival time was 30.4 days. In conclusion, the mortality of patients with ARDS can be reliably correlated with pathological findings on abdominal CT scanning. These results show the importance of initial CT scanning for the evaluation of the prognosis in patients with ARDS. References