临床评估与死后肺部活检在肺透和呼吸系统衰竭患者中的相关性
Chitranshu Vashishtha1, Ankit Bhardwaj2, Prashant M Agarwal3
1Department of Gastroenterology and Hepatology, Institute of Liver and Biliary Sciences, New Delhi, IND.
肝病患者的临床肺炎诊断往往不同意死后肺部组织学. 这项研究强调了在重症监护病房的肝病和呼吸系统衰竭患者中需要准确的诊断方法.
科学领域:
- 肺部病理学 肺部病理学
- 肝病学 肝病学是一种肝病学.
- 关键护理医学 关键护理医学
背景情况:
- 肺部并发症是肝病重症患者死亡的主要原因.
- 肺炎经常在临床上被诊断出来,但往往缺乏确定的放射学或微生物学证据.
- 肝病患者的临床肺炎诊断的准确性与呼吸衰竭是不确定的.
研究的目的:
- 为了将临床肺炎诊断与肝病和呼吸系统衰竭患者的死后肺组织学相关联.
- 与组织学发现相比,评估临床评估的诊断准确性.
主要方法:
- 对108名肝病和呼吸系统衰竭患者的医疗记录和死后肺活检的分析 (2009年9月 - 2020年3月).
- 临床诊断 (放射学和/或微生物学数据) 与组织学发现的比较.
- 对临床肺炎诊断的灵敏度,特异性,正预测值和负预测值的计算.
主要成果:
- 在临床诊断出肺炎的76名患者中,只有43.4%的患者有组织学确认.
- 临床肺炎患者的组织学诊断包括正常/非特异性变化 (35.5%) 和气囊出血 (17.1%).
- 临床诊断和组织学之间的一致性很差 (kappa统计 = 0.12),临床肺炎诊断的特异性低 (34.85%) 和积极预测值 (43.42%).
结论:
- 在重症肝病患者中,临床肺炎诊断和死后肺组织学之间存在显著差异.
- 在这些患者中,死后肺活检对于确定无法解释的死亡原因非常有价值.
- 肝病患者的肺炎的临床诊断呼吸衰竭是不可靠的.
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