Przelew płucny – Rokowania, prognozy i postęp choroby

Przelew płucny
Rokowania, prognozy i postęp choroby

Przelew płucny, zwłaszcza kardiogenny obrzęk płuc, charakteryzuje się wysoką śmiertelnością: około 12% wewnątrzszpitalnie i 40% w perspektywie rocznej, z 50% przeżywalnością roku po wypisie u pacjentów z kardiogennym obrzękiem. Kluczowymi czynnikami prognostycznymi są obecność płynu w opłucnej, dysfunkcja lewej komory oraz parametry kliniczne zawarte w skali PEPS (Pulmonary Edema Prognostic Score), która uwzględnia ostry zawał mięśnia sercowego, częstość akcji serca >115/min, skurczowe ciśnienie tętnicze ≤130 mmHg oraz leukocytozę >11 500/mm³. Wynik PEPS koreluje ze śmiertelnością wewnątrzszpitalną, wahającą się od 2% przy wyniku 0 do 64% przy wyniku 4. Dodatkowo, RALE score, oparty na ocenie radiologicznej, jest istotnym predyktorem opóźnionej ekstubacji po operacjach zastawkowych serca, wykazując korelację z czasem wentylacji mechaniczej (r=0,419) oraz parametrami takimi jak czas krążenia pozaustrojowego, wskaźnik oksygenacji i poziomy BNP.

Prognoza w Przelewach Płucnych (Pulmonary Edema)

Śmiertelność wewnątrzszpitalna i długoterminowa
Czynniki prognostyczne

Skale prognostyczne w ocenie ryzyka pacjentów z przelewie płucnym

Pulmonary Edema Prognostic Score (PEPS)
RALE Score – prognostyk po operacjach zastawkowych

Nowoczesne metody przewidywania rokowania w przelewach płucnych

Głęboka analiza obrazu w ocenie ciężkości przełewu płucnego
Biomarkery w prognozowaniu ryzyka ponownej hospitalizacji
Narzędzia wspomagania decyzji w diagnostyce różnicowej
Kolejne rozdziały

Prognoza w Przelewach Płucnych (Pulmonary Edema)

Przelew płucny (obrzęk płuc) stanowi poważny problem zdrowotny, który wiąże się z niekorzystnym rokowaniem zarówno w okresie hospitalizacji, jak i w perspektywie długoterminowej. Rokowanie w przypadku tej jednostki chorobowej zależy od wielu czynników, w tym od przyczyny podstawowej, nasilenia objawów oraz skuteczności wdrożonego leczenia.¹²

Śmiertelność wewnątrzszpitalna i długoterminowa

Dane z badań naukowych wskazują na wysoką śmiertelność pacjentów z przelewie płucnym. Śmiertelność wewnątrzszpitalna wynosi około 12%, natomiast w perspektywie rocznej wzrasta do alarmującego poziomu 40%.³ Szczególnie niekorzystne rokowanie dotyczy pacjentów z kardiogennym obrzękiem płuc – około 50% pacjentów przeżywa rok od wypisu ze szpitala.⁴ W przypadku niewydolności serca, będącej częstą przyczyną kardiogennego obrzęku płuc, jedna na trzy osoby hospitalizowane z tego powodu przeżywa pięć lub więcej lat od momentu hospitalizacji.⁵

Czynniki prognostyczne

Badania zidentyfikowały szereg czynników, które wpływają na rokowanie u pacjentów z przelewie płucnym:

Obecność płynu w opłucnej jest predyktorem śmiertelności rocznej⁶
Dysfunkcja lewej komory wiąże się z wysoką śmiertelnością wewnątrzszpitalną, ale nie wpływa istotnie na rokowanie długoterminowe⁷

Skale prognostyczne w ocenie ryzyka pacjentów z przelewie płucnym

Pulmonary Edema Prognostic Score (PEPS)

Pulmonary Edema Prognostic Score (PEPS) to narzędzie prognostyczne opracowane do przewidywania śmiertelności wewnątrzszpitalnej u pacjentów z ostrym kardiogennym obrzękiem płuc. Skala PEPS opiera się na łatwo dostępnych parametrach klinicznych i laboratoryjnych.⁸

Najistotniejszymi predyktorami śmiertelności wewnątrzszpitalnej w tej skali są:

Ostry zawał mięśnia sercowego⁹
Częstość akcji serca >115 uderzeń/min¹⁰
Skurczowe ciśnienie tętnicze ≤130 mmHg¹¹
Liczba białych krwinek >11 500/mm³¹²

Wynik PEPS oblicza się jako sumę punktów przyznanych za obecność powyższych czynników. Ryzyko śmiertelności wewnątrzszpitalnej wzrasta wraz z wartością PEPS:

Wynik PEPS	Śmiertelność wewnątrzszpitalna
0	2%
4	64%

PEPS jest prostym narzędziem, które można łatwo obliczyć przy użyciu powszechnie dostępnych testów diagnostycznych (EKG, pomiar ciśnienia tętniczego, częstości akcji serca i liczby białych krwinek), co ułatwia określenie ryzyka śmiertelności wewnątrzszpitalnej u pacjentów z ostrym epizodem kardiogennego obrzęku płuc.¹³

RALE Score – prognostyk po operacjach zastawkowych

Radiographic Assessment of Lung Edema (RALE) score jest wartościowym narzędziem prognostycznym u pacjentów po operacjach zastawkowych serca z wykorzystaniem krążenia pozaustrojowego. Wynik RALE obliczony na podstawie zdjęcia rentgenowskiego klatki piersiowej w pierwszym dniu po operacji jest niezależnym czynnikiem ryzyka przewidującym opóźnioną ekstubację.¹⁴

Badania wykazały, że na opóźnioną ekstubację u pacjentów po zabiegach kardiochirurgicznych wpływają:

Wyższy wynik RALE¹⁵
Dłuższy czas krążenia pozaustrojowego¹⁶
Niższy wskaźnik oksygenacji¹⁷
Podwyższone pooperacyjne poziomy BNP (mózgowego peptydu natriuretycznego)¹⁸

Istnieje dodatnia korelacja między czasem wentylacji mechanicznej a wynikiem RALE u wszystkich pacjentów (współczynnik korelacji 0,419).¹⁹ Model regresji oparty na tych czynnikach charakteryzuje się dobrymi parametrami diagnostycznymi (dokładność 0,737, czułość 0,749, swoistość 0,741, pole pod krzywą AUC 0,825).²⁰

Nowoczesne metody przewidywania rokowania w przelewach płucnych

Głęboka analiza obrazu w ocenie ciężkości przełewu płucnego

Ilościowa ocena obrzęku płuc jest kluczowa, ponieważ jego ciężkość kliniczna może wahać się od łagodnego upośledzenia do stanu zagrażającego życiu.²¹²² W ostatnich latach opracowano modele głębokiego uczenia maszynowego, które umożliwiają dokładną kwantyfikację obrzęku płuc na podstawie zdjęć rentgenowskich klatki piersiowej.²³²⁴

Modele te wykazują bardzo dobre do doskonałych wyniki, zwłaszcza gdy dzielą dostępne dane na maksymalnie pięć klas dla klinicznie najbardziej istotnego zakresu EVLWI (pozanaczyniowa woda płucna) od 6 do 20.²⁵ Pomimo pewnych ograniczeń, badania dowodzą, że głębokie uczenie jest użytecznym narzędziem do kwantyfikacji obrzęku płuc z istotną rozdzielczością i wysoką dokładnością.²⁶²⁶

Biomarkery w prognozowaniu ryzyka ponownej hospitalizacji

Nowe badania koncentrują się również na identyfikacji biomarkerów mogących pomóc w przewidywaniu rokowania u pacjentów z przelewie płucnym. Jednym z takich biomarkerów jest miR-30d, który wykazuje istotną wartość predykcyjną w ocenie ryzyka ponownej hospitalizacji zarówno po 3 miesiącach, jak i po roku od początkowej diagnozy ostrego kardiogennego obrzęku płuc (ACPE).²⁷

Wyniki badań sugerują, że:

Podwyższone poziomy miR-30d wiążą się ze zwiększonym wskaźnikiem ponownych hospitalizacji zarówno po 3 miesiącach, jak i po roku od wypisu²⁸
Poziomy miR-30d mierzone przy przyjęciu na SOR i miesiąc później u pacjentów z ACPE nie przewidują odpowiedzi na terapię, poprawy frakcji wyrzutowej po roku ani śmiertelności rocznej²⁹
Dokładność diagnostyczna jest znacznie wyższa dla poziomów miR-30d mierzonych po miesiącu niż przy przyjęciu, co sugeruje, że utrzymywanie się podwyższonych poziomów miR-30d we krwi może być związane z utrzymywaniem się mechanizmów patogennych leżących u podstaw zwiększonego ryzyka ponownej hospitalizacji³⁰

Badania potwierdzają potencjalną użyteczność miR-30d jako biomarkera u pacjentów z niewydolnością serca, sugerując, że miR-30d może dostarczyć dodatkowych, cennych informacji w zarządzaniu pacjentem.³¹ Wyniki podkreślają potencjał krążących poziomów miR-30d jako biomarkera predykcyjnego ryzyka ponownej hospitalizacji u pacjentów z ACPE.³²

Narzędzia wspomagania decyzji w diagnostyce różnicowej

Narzędzia wspomagania decyzji klinicznych mogą poprawić diagnostykę różnicową między zespołem ostrej niewydolności oddechowej (ARDS) a kardiogennym obrzękiem płuc (CPE), co jest kluczowe dla właściwego leczenia i rokowania.³³

Opracowane kliniczne skale predykcyjne wiarygodnie różnicują ARDS/ALI od CPE. Zbiorcze wyniki badań dostarczają precyzyjnych oszacowań skuteczności tych skal, które można wykorzystać do przesiewowego badania populacji pacjentów lub do oceny prawdopodobieństwa wystąpienia ALI/ARDS w przeciwieństwie do CPE u konkretnych pacjentów.³⁴

Prospektywna walidacja dostarcza dalszych dowodów na to, że skale predykcyjne dobrze różnicują pacjentów z ARDS i CPE. Kliniczne skale predykcyjne mogą zatem ułatwić wczesne włączenie do badań naukowych i przyspieszyć wdrożenie krytycznych środków leczniczych.³⁵³⁶

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Cardiogenic Pulmonary Edema: Causes, Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/22941-cardiogenic-pulmonary-edema
Pulmonary edema is life-threatening, but your prognosis depends on what caused it. […] One year after discharge from a hospital, about 50% survive cardiac edema. […] Heart failure, a common cause of cardiogenic pulmonary edema, is a chronic disease that can get better with treatment. Out of every three people who’ve been in the hospital because of heart failure, one person lives five or more years after their stay.
#2 Long-term prognosis of acute pulmonary oedema–an ominous outcome – PubMed
https://pubmed.ncbi.nlm.nih.gov/10856726/
Acute pulmonary oedema (APOE) is a major health problem, leading to poor hospital and long-term outcomes. […] The overall mortality is high (in-hospital, 12%: 1-year, 40%). […] Only the presence of pleural effusion was found as a predictor for 1-year mortality. […] Left ventricular dysfunction was associated with high in-hospital mortality, but not with long-term prognosis.
#3 Long-term prognosis of acute pulmonary oedema–an ominous outcome – PubMed
https://pubmed.ncbi.nlm.nih.gov/10856726/
Acute pulmonary oedema (APOE) is a major health problem, leading to poor hospital and long-term outcomes. […] The overall mortality is high (in-hospital, 12%: 1-year, 40%). […] Only the presence of pleural effusion was found as a predictor for 1-year mortality. […] Left ventricular dysfunction was associated with high in-hospital mortality, but not with long-term prognosis.
#4 Cardiogenic Pulmonary Edema: Causes, Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/22941-cardiogenic-pulmonary-edema
Pulmonary edema is life-threatening, but your prognosis depends on what caused it. […] One year after discharge from a hospital, about 50% survive cardiac edema. […] Heart failure, a common cause of cardiogenic pulmonary edema, is a chronic disease that can get better with treatment. Out of every three people who’ve been in the hospital because of heart failure, one person lives five or more years after their stay.
#5 Cardiogenic Pulmonary Edema: Causes, Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/22941-cardiogenic-pulmonary-edema
Pulmonary edema is life-threatening, but your prognosis depends on what caused it. […] One year after discharge from a hospital, about 50% survive cardiac edema. […] Heart failure, a common cause of cardiogenic pulmonary edema, is a chronic disease that can get better with treatment. Out of every three people who’ve been in the hospital because of heart failure, one person lives five or more years after their stay.
#6 Long-term prognosis of acute pulmonary oedema–an ominous outcome – PubMed
https://pubmed.ncbi.nlm.nih.gov/10856726/
Acute pulmonary oedema (APOE) is a major health problem, leading to poor hospital and long-term outcomes. […] The overall mortality is high (in-hospital, 12%: 1-year, 40%). […] Only the presence of pleural effusion was found as a predictor for 1-year mortality. […] Left ventricular dysfunction was associated with high in-hospital mortality, but not with long-term prognosis.
#7 Long-term prognosis of acute pulmonary oedema–an ominous outcome – PubMed
https://pubmed.ncbi.nlm.nih.gov/10856726/
Acute pulmonary oedema (APOE) is a major health problem, leading to poor hospital and long-term outcomes. […] The overall mortality is high (in-hospital, 12%: 1-year, 40%). […] Only the presence of pleural effusion was found as a predictor for 1-year mortality. […] Left ventricular dysfunction was associated with high in-hospital mortality, but not with long-term prognosis.
#8 Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema – PubMed
https://pubmed.ncbi.nlm.nih.gov/18206526/
Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema. […] The goal of this investigation was to develop a simple prognostic score predicting in-hospital outcome in patients with acute cardiogenic pulmonary edema. […] Statistical analyses revealed that the most significant predictors of inhospital mortality were acute myocardial infarction, heart rate greater than 115/beats/min, systolic blood pressure of 130 mm Hg or less, and white blood cell count greater than 11,500/mm3 on presentation. […] The Pulmonary Edema Prognostic Score (PEPS) was defined as a sum of all points. Patients with a PEPS of 0 had good short-term prognosis with a 2% in-hospital mortality rate, whereas mortality in patients with a PEPS of 4 was 64%. […] The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.
#9 Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema – PubMed
https://pubmed.ncbi.nlm.nih.gov/18206526/
Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema. […] The goal of this investigation was to develop a simple prognostic score predicting in-hospital outcome in patients with acute cardiogenic pulmonary edema. […] Statistical analyses revealed that the most significant predictors of inhospital mortality were acute myocardial infarction, heart rate greater than 115/beats/min, systolic blood pressure of 130 mm Hg or less, and white blood cell count greater than 11,500/mm3 on presentation. […] The Pulmonary Edema Prognostic Score (PEPS) was defined as a sum of all points. Patients with a PEPS of 0 had good short-term prognosis with a 2% in-hospital mortality rate, whereas mortality in patients with a PEPS of 4 was 64%. […] The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.
#10 Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema – PubMed
https://pubmed.ncbi.nlm.nih.gov/18206526/
Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema. […] The goal of this investigation was to develop a simple prognostic score predicting in-hospital outcome in patients with acute cardiogenic pulmonary edema. […] Statistical analyses revealed that the most significant predictors of inhospital mortality were acute myocardial infarction, heart rate greater than 115/beats/min, systolic blood pressure of 130 mm Hg or less, and white blood cell count greater than 11,500/mm3 on presentation. […] The Pulmonary Edema Prognostic Score (PEPS) was defined as a sum of all points. Patients with a PEPS of 0 had good short-term prognosis with a 2% in-hospital mortality rate, whereas mortality in patients with a PEPS of 4 was 64%. […] The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.
#11 Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema – PubMed
https://pubmed.ncbi.nlm.nih.gov/18206526/
Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema. […] The goal of this investigation was to develop a simple prognostic score predicting in-hospital outcome in patients with acute cardiogenic pulmonary edema. […] Statistical analyses revealed that the most significant predictors of inhospital mortality were acute myocardial infarction, heart rate greater than 115/beats/min, systolic blood pressure of 130 mm Hg or less, and white blood cell count greater than 11,500/mm3 on presentation. […] The Pulmonary Edema Prognostic Score (PEPS) was defined as a sum of all points. Patients with a PEPS of 0 had good short-term prognosis with a 2% in-hospital mortality rate, whereas mortality in patients with a PEPS of 4 was 64%. […] The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.
#12 Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema – PubMed
https://pubmed.ncbi.nlm.nih.gov/18206526/
Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema. […] The goal of this investigation was to develop a simple prognostic score predicting in-hospital outcome in patients with acute cardiogenic pulmonary edema. […] Statistical analyses revealed that the most significant predictors of inhospital mortality were acute myocardial infarction, heart rate greater than 115/beats/min, systolic blood pressure of 130 mm Hg or less, and white blood cell count greater than 11,500/mm3 on presentation. […] The Pulmonary Edema Prognostic Score (PEPS) was defined as a sum of all points. Patients with a PEPS of 0 had good short-term prognosis with a 2% in-hospital mortality rate, whereas mortality in patients with a PEPS of 4 was 64%. […] The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.
#13 Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema – PubMed
https://pubmed.ncbi.nlm.nih.gov/18206526/
Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema. […] The goal of this investigation was to develop a simple prognostic score predicting in-hospital outcome in patients with acute cardiogenic pulmonary edema. […] Statistical analyses revealed that the most significant predictors of inhospital mortality were acute myocardial infarction, heart rate greater than 115/beats/min, systolic blood pressure of 130 mm Hg or less, and white blood cell count greater than 11,500/mm3 on presentation. […] The Pulmonary Edema Prognostic Score (PEPS) was defined as a sum of all points. Patients with a PEPS of 0 had good short-term prognosis with a 2% in-hospital mortality rate, whereas mortality in patients with a PEPS of 4 was 64%. […] The PEPS is a simple tool that can be easily calculated using common clinical diagnostic tests (electrocardiogram, blood pressure, heart rate, and white cell count) to determine in-hospital mortality risk in patients with an acute episode of cardiogenic pulmonary edema.
#14 Study on the Predictive Value of a Pulmonary Edema Imaging Score for Delayed Extubation in Patients after Heart Valve Surgery on Cardiopulmonary Bypass
https://www.imrpress.com/journal/RCM/25/10/10.31083/j.rcm2510387/htm
The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value. […] Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, P aCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation. […] The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant. […] Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. […] A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively.
#15 Study on the Predictive Value of a Pulmonary Edema Imaging Score for Delayed Extubation in Patients after Heart Valve Surgery on Cardiopulmonary Bypass
https://www.imrpress.com/journal/RCM/25/10/10.31083/j.rcm2510387/htm
The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value. […] Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, P aCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation. […] The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant. […] Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. […] A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively.
#16 Study on the Predictive Value of a Pulmonary Edema Imaging Score for Delayed Extubation in Patients after Heart Valve Surgery on Cardiopulmonary Bypass
https://www.imrpress.com/journal/RCM/25/10/10.31083/j.rcm2510387/htm
The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value. […] Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, P aCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation. […] The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant. […] Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. […] A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively.
#17 Study on the Predictive Value of a Pulmonary Edema Imaging Score for Delayed Extubation in Patients after Heart Valve Surgery on Cardiopulmonary Bypass
https://www.imrpress.com/journal/RCM/25/10/10.31083/j.rcm2510387/htm
The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value. […] Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, P aCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation. […] The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant. […] Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. […] A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively.
#18 Study on the Predictive Value of a Pulmonary Edema Imaging Score for Delayed Extubation in Patients after Heart Valve Surgery on Cardiopulmonary Bypass
https://www.imrpress.com/journal/RCM/25/10/10.31083/j.rcm2510387/htm
The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value. […] Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, P aCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation. […] The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant. […] Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. […] A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively.
#19 Study on the Predictive Value of a Pulmonary Edema Imaging Score for Delayed Extubation in Patients after Heart Valve Surgery on Cardiopulmonary Bypass
https://www.imrpress.com/journal/RCM/25/10/10.31083/j.rcm2510387/htm
The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value. […] Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, P aCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation. […] The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant. […] Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. […] A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively.
#20 Study on the Predictive Value of a Pulmonary Edema Imaging Score for Delayed Extubation in Patients after Heart Valve Surgery on Cardiopulmonary Bypass
https://www.imrpress.com/journal/RCM/25/10/10.31083/j.rcm2510387/htm
The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value. […] Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, P aCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation. […] The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant. […] Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. […] A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively.
#21 A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04426-5
A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. […] Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy. […] In this study, we sequentially developed a deep learning model that accurately quantifies pulmonary edema from chest X-ray images. […] Despite these limitations our study demonstrates, that deep learning is a useful tool for the quantification of pulmonary edema with a meaningful resolution with high accuracy.
#22 A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays | springermedizin.de
https://www.springermedizin.de/a-deep-learning-model-enables-accurate-prediction-and-quantifica/25411708
A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. […] Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy. […] In this study, we sequentially developed a deep learning model that accurately quantifies pulmonary edema from chest X-ray images. […] Our models show very good to excellent performances when binning the available data up to five classes for the clinically most relevant EVLWI range from 6 to 20. […] Despite these limitations our study demonstrates, that deep learning is a useful tool for the quantification of pulmonary edema with a meaningful resolution with high accuracy.
#23 A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04426-5
A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. […] Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy. […] In this study, we sequentially developed a deep learning model that accurately quantifies pulmonary edema from chest X-ray images. […] Despite these limitations our study demonstrates, that deep learning is a useful tool for the quantification of pulmonary edema with a meaningful resolution with high accuracy.
#24 A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays | springermedizin.de
https://www.springermedizin.de/a-deep-learning-model-enables-accurate-prediction-and-quantifica/25411708
A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. […] Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy. […] In this study, we sequentially developed a deep learning model that accurately quantifies pulmonary edema from chest X-ray images. […] Our models show very good to excellent performances when binning the available data up to five classes for the clinically most relevant EVLWI range from 6 to 20. […] Despite these limitations our study demonstrates, that deep learning is a useful tool for the quantification of pulmonary edema with a meaningful resolution with high accuracy.
#25 A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays | springermedizin.de
https://www.springermedizin.de/a-deep-learning-model-enables-accurate-prediction-and-quantifica/25411708
A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. […] Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy. […] In this study, we sequentially developed a deep learning model that accurately quantifies pulmonary edema from chest X-ray images. […] Our models show very good to excellent performances when binning the available data up to five classes for the clinically most relevant EVLWI range from 6 to 20. […] Despite these limitations our study demonstrates, that deep learning is a useful tool for the quantification of pulmonary edema with a meaningful resolution with high accuracy.
#26 A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04426-5
A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. […] Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy. […] In this study, we sequentially developed a deep learning model that accurately quantifies pulmonary edema from chest X-ray images. […] Despite these limitations our study demonstrates, that deep learning is a useful tool for the quantification of pulmonary edema with a meaningful resolution with high accuracy.
#26 A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays | springermedizin.de
https://www.springermedizin.de/a-deep-learning-model-enables-accurate-prediction-and-quantifica/25411708
A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. […] Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy. […] In this study, we sequentially developed a deep learning model that accurately quantifies pulmonary edema from chest X-ray images. […] Our models show very good to excellent performances when binning the available data up to five classes for the clinically most relevant EVLWI range from 6 to 20. […] Despite these limitations our study demonstrates, that deep learning is a useful tool for the quantification of pulmonary edema with a meaningful resolution with high accuracy.
#27 miR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study
https://www.mdpi.com/1422-0067/26/3/1278
miR-30d had a significant predictive value in assessing the risk of re-hospitalization at both 3 months and 1 year following the initial diagnosis of ACPE, while it did not in assessing the risk of death at 1 year. […] Our findings suggest that elevated levels of miR-30d are associated with an increased rate of hospital readmission at both 3 months and 1 year after discharge. […] These findings indicate that miR-30d levels measured at ED admission and one month later in ACPE patients do not predict therapy response, EF improvement at one year, or one-year mortality. Instead, they appear to reflect acute pathophysiological conditions rather than long-term outcomes. […] This diagnostic accuracy was significantly higher for miR-30d levels at T1 than at T0, suggesting that the persistence of elevated miR-30d blood levels might be associated with the persistence of those pathogenic mechanisms underlying an increased re-hospitalization risk.
#28 miR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study
https://www.mdpi.com/1422-0067/26/3/1278
miR-30d had a significant predictive value in assessing the risk of re-hospitalization at both 3 months and 1 year following the initial diagnosis of ACPE, while it did not in assessing the risk of death at 1 year. […] Our findings suggest that elevated levels of miR-30d are associated with an increased rate of hospital readmission at both 3 months and 1 year after discharge. […] These findings indicate that miR-30d levels measured at ED admission and one month later in ACPE patients do not predict therapy response, EF improvement at one year, or one-year mortality. Instead, they appear to reflect acute pathophysiological conditions rather than long-term outcomes. […] This diagnostic accuracy was significantly higher for miR-30d levels at T1 than at T0, suggesting that the persistence of elevated miR-30d blood levels might be associated with the persistence of those pathogenic mechanisms underlying an increased re-hospitalization risk.
#29 miR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study
https://www.mdpi.com/1422-0067/26/3/1278
miR-30d had a significant predictive value in assessing the risk of re-hospitalization at both 3 months and 1 year following the initial diagnosis of ACPE, while it did not in assessing the risk of death at 1 year. […] Our findings suggest that elevated levels of miR-30d are associated with an increased rate of hospital readmission at both 3 months and 1 year after discharge. […] These findings indicate that miR-30d levels measured at ED admission and one month later in ACPE patients do not predict therapy response, EF improvement at one year, or one-year mortality. Instead, they appear to reflect acute pathophysiological conditions rather than long-term outcomes. […] This diagnostic accuracy was significantly higher for miR-30d levels at T1 than at T0, suggesting that the persistence of elevated miR-30d blood levels might be associated with the persistence of those pathogenic mechanisms underlying an increased re-hospitalization risk.
#30 miR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study
https://www.mdpi.com/1422-0067/26/3/1278
miR-30d had a significant predictive value in assessing the risk of re-hospitalization at both 3 months and 1 year following the initial diagnosis of ACPE, while it did not in assessing the risk of death at 1 year. […] Our findings suggest that elevated levels of miR-30d are associated with an increased rate of hospital readmission at both 3 months and 1 year after discharge. […] These findings indicate that miR-30d levels measured at ED admission and one month later in ACPE patients do not predict therapy response, EF improvement at one year, or one-year mortality. Instead, they appear to reflect acute pathophysiological conditions rather than long-term outcomes. […] This diagnostic accuracy was significantly higher for miR-30d levels at T1 than at T0, suggesting that the persistence of elevated miR-30d blood levels might be associated with the persistence of those pathogenic mechanisms underlying an increased re-hospitalization risk.
#31 miR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study
https://www.mdpi.com/1422-0067/26/3/1278
Our results confirm those already discussed on the potential utility of miR-30d as a biomarker in patients with HF, suggesting that miR-30d could offer additional, valuable information in patient management. […] In conclusion, our findings highlight the potential of circulating miR-30d levels as a predictive biomarker for re-hospitalization risk in ACPE patients.
#32 miR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study
https://www.mdpi.com/1422-0067/26/3/1278
Our results confirm those already discussed on the potential utility of miR-30d as a biomarker in patients with HF, suggesting that miR-30d could offer additional, valuable information in patient management. […] In conclusion, our findings highlight the potential of circulating miR-30d levels as a predictive biomarker for re-hospitalization risk in ACPE patients.
#33 Decision support tool for differential diagnosis of Acute Respiratory Distress Syndrome (ARDS) vs Cardiogenic Pulmonary Edema (CPE): a prospective validation and meta-analysis | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0659-x
The clinical prediction score reliably differentiates ARDS/ALI vs CPE. […] Pooled results provide precise estimates of the scores performance which can be used to screen patient populations or to assess the probability of ALI/ARDS vs CPE in specific patients. […] This prospective validation provides further evidence that the prediction score differentiates well between ARDS and CPE patients. […] The clinical prediction score may thus facilitate early inclusion into research studies and expedite the initiation of critical treatment measures.
#34 Decision support tool for differential diagnosis of Acute Respiratory Distress Syndrome (ARDS) vs Cardiogenic Pulmonary Edema (CPE): a prospective validation and meta-analysis | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0659-x
The clinical prediction score reliably differentiates ARDS/ALI vs CPE. […] Pooled results provide precise estimates of the scores performance which can be used to screen patient populations or to assess the probability of ALI/ARDS vs CPE in specific patients. […] This prospective validation provides further evidence that the prediction score differentiates well between ARDS and CPE patients. […] The clinical prediction score may thus facilitate early inclusion into research studies and expedite the initiation of critical treatment measures.
#35 Decision support tool for differential diagnosis of Acute Respiratory Distress Syndrome (ARDS) vs Cardiogenic Pulmonary Edema (CPE): a prospective validation and meta-analysis | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0659-x
The clinical prediction score reliably differentiates ARDS/ALI vs CPE. […] Pooled results provide precise estimates of the scores performance which can be used to screen patient populations or to assess the probability of ALI/ARDS vs CPE in specific patients. […] This prospective validation provides further evidence that the prediction score differentiates well between ARDS and CPE patients. […] The clinical prediction score may thus facilitate early inclusion into research studies and expedite the initiation of critical treatment measures.
#36 Decision support tool for differential diagnosis of Acute Respiratory Distress Syndrome (ARDS) vs Cardiogenic Pulmonary Edema (CPE): a prospective validation and meta-analysis | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0659-x
The clinical prediction score reliably differentiates ARDS/ALI vs CPE. […] Pooled results provide precise estimates of the scores performance which can be used to screen patient populations or to assess the probability of ALI/ARDS vs CPE in specific patients. […] This prospective validation provides further evidence that the prediction score differentiates well between ARDS and CPE patients. […] The clinical prediction score may thus facilitate early inclusion into research studies and expedite the initiation of critical treatment measures.