The Portal-Venous Enhancement Ratio of the Adrenal Glands and Spleen as a Short-Term Predictor of Mortality in Intensive Care Patients

Abstract

Background In critically ill ICU patients, initial results showed that opposite enhancement of the adrenal glands (↑) and spleen (↓) on portal venous CT scans was associated with increased mortality over the next days to a month, with short-term mortality being best predicted. The study aimed to validate the adrenal-to-spleen ratio determined in a pilot study concerning mortality prediction. Method 371 portal venous CT scans of 203 ICU patients (127 men, age: 68.1 ± 14.4 years) were included in the retrospective analysis. Region-of-interest (ROI)-based Hounsfield units of the adrenal glands and the spleen and their density ratio were evaluated. The Matthews correlation coefficient (MCC) and ROC analysis were used to establish a threshold for the adrenal-to-spleen ratio regarding mortality within 72 hours of imaging. The quality of the classification of survivors and deceased patients in the current collective based on the threshold determined in a pilot study and on the current threshold was determined. The precision-recall curve (PRC) was used to test the influence of the addition of patients with low vital risk on the ROC. Results The current threshold of 1.37 for the adrenal-to-spleen ratio provides good discriminatory power between those who died and those who survived (MCC: 0.87; sensitivity: 83.7 %; specificity: 99.1 %; PPV: 93.2 %; NPV: 97.6 %) and differs only slightly from the threshold of 1.41 determined in the pilot study, which consequently has comparable discriminatory power. Conclusion As a reproducible image-based prognostic marker, the portal venous adrenal-to-spleen ratio has a high predictive power for short-term death in ICU patients. It is, therefore, suitable as an indicator of high risk of death within 72 hours after imaging. Key Points: Citation Format

Portal venous contrast enhancement ratio of the adrenal glands and spleen as prognostic marker of mortality in patients with acute mesenteric ischemia

“…That is why there is definite need for further quantitative parameters to correctly predict a poor clinical outcome in patients with AMI. This would be crucial as the investigated radiodensities parameters in the current study were already demonstrated to be of prognostic relevance in critically ill patients [ 5 – 7 ].…”

“…In a variety of critically ill patients of the intensive care unit (ICU), Winzer et al demonstrated that the portal venous adrenal-to-spleen ratio is a good predictor for mortality based on the CT hypoperfusions complex. This study population included 10.5% patients with acute mesenteric ischemia [ 5 ]. A higher mortality was seen in patients with a relative hyperperfusion of the adrenal glands in comparison with a hypoperfusion of the spleen.…”

“…A higher mortality was seen in patients with a relative hyperperfusion of the adrenal glands in comparison with a hypoperfusion of the spleen. While hypoperfusion of the spleen was also correlated with higher mortality, the adrenal-to-spleen ratio in a portal venous phase showed the best discriminatory power to predict mortality [ 5 ]. Other studies have also demonstrated the potential benefit of this novel quantitative imaging marker in other populations with critically illness [ 6 – 9 ].…”

Association between the dynamic movement of hyperechoic foci and patients'/sonographic outcomes among pediatric patients with portal venous gas following a cardiac event

“…To‐and‐fro movement of hyperechoic foci within the intrahepatic portal vein indicates that perfusion pressure within the portal venous system is not preserved, which may result in severe intestinal damage 36,37 . In patients needing intensive care, severe systemic congestion resulted in variation of portal venous waveform 38,39 .…”

“…To-and-fro movement of hyperechoic foci within the intrahepatic portal vein indicates that perfusion pressure within the portal venous system is not preserved, which may result in severe intestinal damage. 36,37 In patients needing intensive care, severe systemic congestion resulted in variation of portal venous waveform. 38,39 This waveform variation might be associated with the sonographic findings, such as the to-and-fro movement of hyperechoic foci within the intrahepatic portal vein.…”