Dokument: Stellt die morphologische Dichtemessung der Lungentextur in der Computertomographie bei Patienten mit mechanischer Kreislaufunterstützung einen Prognoseparameter bei Covid-19 positiven Patienten dar?
| Titel: | Stellt die morphologische Dichtemessung der Lungentextur in der Computertomographie bei Patienten mit mechanischer Kreislaufunterstützung einen Prognoseparameter bei Covid-19 positiven Patienten dar? | |||||||
| Weiterer Titel: | Does the morphological density measurement of the lung texture in computed tomography in patients with mechanical circulatory support represent a prognostic parameter in Covid-19 positive patients? | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=65382 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20240327-141635-5 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Domröse, Nils [Autor] | |||||||
| Dateien: |
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| Beitragende: | PD Dr. med. Dalyanoglu, Hannan [Gutachter] PD Dr. med. Kirchner, Julian [Gutachter] | |||||||
| Stichwörter: | Covid-19, ECMO, CT, Dichtemessungen | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Diese Studie untersucht die prognostische Aussagefähigkeit der computertomographischen Dichtemessung des Thorax bei ECMO-pflichtigen Covid-19 positiven Patienten. Physiologisches Lungen¬gewebe weist im Durchschnitt eine niedrige Dichte um -870 Hounsfield units (HU) auf. Bei höheren Dichtewerten liegt eine pathologische Veränderung vor.
Für die retrospektive Beurteilung eines Zusammenhangs zwischen der im Verlauf auftretenden Dichteveränderung und der Überlebenswahrscheinlichkeit bei Covid-19 positiven Patienten wurden in der klinischen Routine durchgeführten CT-Untersuchungen von 66 Patienten genutzt. Zusätzlich wurde eine Kontrollgruppe aus 32 Patienten mit einer venovenösen extrakorporalen Membran¬oyxgenierung ohne Covid-19 gebildet. Für die Dichtemessungen in den CT-Untersuchungen wurde in jedem Lungenlappen jeweils zentral und peripher die Dichte des Lungenparenchyms gemessen (insgesamt 10 Regions of Interest). Danach wurden die sequenziellen Dichte¬veränderungen betrachtet und abschließend ein Vergleich mit der Covid-19 negativen Kontrollgruppe evaluiert. Die statistische Auswertung erfolgte mit dem Statistikprogramm SPSS. Die Covid-19-Patienten wurden in zwei Subgruppen aufgeteilt: Die eine Subgruppe hatte eine überdurchschnittlich hohe Lungendichte, die andere eine niedrigere Lungendichte. Durch eine ROC-Kurve konnte ein optimierter Trennwert von -313,1 HU ermittelt werden. Die Covid-19-Patienten mit einer höheren Dichte als -313,1 HU wiesen dabei eine höhere Überlebenswahrscheinlichkeit (χ²(1) = 3,88, p = 0,049, φ = 0,049). Diese bessere Prognose zeigt sich auch in Überlebenskurven (Log-Rank-Test: χ²(1) = 7,96, p = 0,005) auf. Die Hazard Ratio für Covid-19-Patienten mit niedriger Dichte war mehr als zwei Mal so groß (eB = 2,232; 95%-KI: 1,247-3,995). Die mittlere Überlebenszeit lag 14 Tage höher. Dieses Ergebnis ist auf den ersten Blick überraschend. Möglicherweise führten bei den Patienten mit niedrigeren Dichtewerten vorrangig andere Ursachen zum Tod, sodass sie weniger von einer ECMO-Therapie profitieren. Bei allen Covid-19-Patienten ergab sich innerhalb der Verlaufsuntersuchungen eine signifikante Reduktion der Dichtemittelwerte (p < 0,001). Innerhalb der Kontrollgruppe gab es keinen Zusammenhang zwischen einer hohen Lungendichte und dem Überleben. Die hier gefundenen Daten zeigen für Patienten mit schwerer Covid-19-Pneumonie, dass eine extrakorporale Membranoxygenierung besonders dann einen Überlebensvorteil bietet, wenn die durchschnittliche Lungendichte besonders hoch ist.This study investigates the prognostic value of computed tomographic density measurement of the thorax in ECMO-requiring Covid-19 positive patients. Physiological lung tissue has a low average density of -870 Hounsfield units (HU). Higher density values indicate a pathological change. For the retrospective assessment of a correlation between the density change occurring during the course and the probability of survival in Covid-19-positive patients, CT examinations of 66 patients performed in routine clinical practice were used. In addition, a control group of 32 patients with venovenous extracorporeal membrane oxygenation without Covid-19 was formed. For the density measurements in the CT scans, the density of the lung parenchyma was measured centrally and peripherally in each lung lobe (a total of 10 regions of interest). Then the sequential density changes were considered and finally a comparison with the Covid-19-negative control group was evaluated. Statistical analysis was performed using the SPSS statistical programme. The Covid-19-patients were divided into two subgroups: One subgroup had a higher-than-average lung density, the other a lower lung density. Through an ROC curve, an optimised separation value of -313,1 HU could be determined. The Covid-19-patients with a higher density than -313,1 HU showed a higher probability of survival (χ²(1) = 3,88, p = 0,049, φ = 0,049). This better prognosis is also reflected in survival curves (log-rank test: χ²(1) = 7,96, p = 0,005). The hazard ratio for low-density Covid-19-patients was more than two times greater (eB = 2,232; 95% CI: 1,247-3,995). The median survival time was 14 days higher. This result is surprising at first sight. It is possible that the patients with lower density values died primarily from other causes, so that they benefit less from ECMO therapy. In all Covid-19-patients, there was a significant reduction in mean density values within the follow-up examinations (p < 0,001). Within the control group, there was no association between high lung density and survival. The data found here show for patients with severe Covid-19-pneumonia that extracorporeal membrane oxygenation offers a survival advantage especially when the mean lung density is particularly high. | |||||||
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| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Bezug: | 2020-2024 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 27.03.2024 | |||||||
| Dateien geändert am: | 27.03.2024 | |||||||
| Promotionsantrag am: | 26.10.2023 | |||||||
| Datum der Promotion: | 26.03.2024 |
