Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission
(1) Background: Extracorporeal membrane oxygenation (ECMO) therapy in intensive care units (ICUs) remains the last treatment option for Coronavirus disease 2019 (COVID-19) patients with severely affected lungs but is highly resource demanding. Early risk stratification for the need of ECMO therapy u...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-06-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/11/6/1029 |
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| author | Eva Gresser Jakob Reich Bastian O. Sabel Wolfgang G. Kunz Matthias P. Fabritius Johannes Rübenthaler Michael Ingrisch Dietmar Wassilowsky Michael Irlbeck Jens Ricke Daniel Puhr-Westerheide |
| author_facet | Eva Gresser Jakob Reich Bastian O. Sabel Wolfgang G. Kunz Matthias P. Fabritius Johannes Rübenthaler Michael Ingrisch Dietmar Wassilowsky Michael Irlbeck Jens Ricke Daniel Puhr-Westerheide |
| author_sort | Eva Gresser |
| collection | DOAJ |
| description | (1) Background: Extracorporeal membrane oxygenation (ECMO) therapy in intensive care units (ICUs) remains the last treatment option for Coronavirus disease 2019 (COVID-19) patients with severely affected lungs but is highly resource demanding. Early risk stratification for the need of ECMO therapy upon admission to the hospital using artificial intelligence (AI)-based computed tomography (CT) assessment and clinical scores is beneficial for patient assessment and resource management; (2) Methods: Retrospective single-center study with 95 confirmed COVID-19 patients admitted to the participating ICUs. Patients requiring ECMO therapy (<i>n</i> = 14) during ICU stay versus patients without ECMO treatment (<i>n</i> = 81) were evaluated for discriminative clinical prediction parameters and AI-based CT imaging features and their diagnostic potential to predict ECMO therapy. Reported patient data include clinical scores, AI-based CT findings and patient outcomes; (3) Results: Patients subsequently allocated to ECMO therapy had significantly higher sequential organ failure (SOFA) scores (<i>p</i> < 0.001) and significantly lower oxygenation indices on admission (<i>p</i> = 0.009) than patients with standard ICU therapy. The median time from hospital admission to ECMO placement was 1.4 days (IQR 0.2–4.0). The percentage of lung involvement on AI-based CT assessment on admission to the hospital was significantly higher in ECMO patients (<i>p</i> < 0.001). In binary logistic regression analyses for ECMO prediction including age, sex, body mass index (BMI), SOFA score on admission, lactate on admission and percentage of lung involvement on admission CTs, only SOFA score (OR 1.32, 95% CI 1.08–1.62) and lung involvement (OR 1.06, 95% CI 1.01–1.11) were significantly associated with subsequent ECMO allocation. Receiver operating characteristic (ROC) curves showed an area under the curve (AUC) of 0.83 (95% CI 0.73–0.94) for lung involvement on admission CT and 0.82 (95% CI 0.72–0.91) for SOFA scores on ICU admission. A combined parameter of SOFA on ICU admission and lung involvement on admission CT yielded an AUC of 0.91 (0.84–0.97) with a sensitivity of 0.93 and a specificity of 0.84 for ECMO prediction; (4) Conclusions: AI-based assessment of lung involvement on CT scans on admission to the hospital and SOFA scoring, especially if combined, can be used as risk stratification tools for subsequent requirement for ECMO therapy in patients with severe COVID-19 disease to improve resource management in ICU settings. |
| first_indexed | 2024-03-10T10:44:22Z |
| format | Article |
| id | doaj.art-df3f412227b94e7c893197e388021518 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T10:44:22Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-df3f412227b94e7c893197e3880215182023-11-21T22:43:38ZengMDPI AGDiagnostics2075-44182021-06-01116102910.3390/diagnostics11061029Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on AdmissionEva Gresser0Jakob Reich1Bastian O. Sabel2Wolfgang G. Kunz3Matthias P. Fabritius4Johannes Rübenthaler5Michael Ingrisch6Dietmar Wassilowsky7Michael Irlbeck8Jens Ricke9Daniel Puhr-Westerheide10Department of Radiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Radiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Radiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Radiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Radiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Radiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Radiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Radiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany(1) Background: Extracorporeal membrane oxygenation (ECMO) therapy in intensive care units (ICUs) remains the last treatment option for Coronavirus disease 2019 (COVID-19) patients with severely affected lungs but is highly resource demanding. Early risk stratification for the need of ECMO therapy upon admission to the hospital using artificial intelligence (AI)-based computed tomography (CT) assessment and clinical scores is beneficial for patient assessment and resource management; (2) Methods: Retrospective single-center study with 95 confirmed COVID-19 patients admitted to the participating ICUs. Patients requiring ECMO therapy (<i>n</i> = 14) during ICU stay versus patients without ECMO treatment (<i>n</i> = 81) were evaluated for discriminative clinical prediction parameters and AI-based CT imaging features and their diagnostic potential to predict ECMO therapy. Reported patient data include clinical scores, AI-based CT findings and patient outcomes; (3) Results: Patients subsequently allocated to ECMO therapy had significantly higher sequential organ failure (SOFA) scores (<i>p</i> < 0.001) and significantly lower oxygenation indices on admission (<i>p</i> = 0.009) than patients with standard ICU therapy. The median time from hospital admission to ECMO placement was 1.4 days (IQR 0.2–4.0). The percentage of lung involvement on AI-based CT assessment on admission to the hospital was significantly higher in ECMO patients (<i>p</i> < 0.001). In binary logistic regression analyses for ECMO prediction including age, sex, body mass index (BMI), SOFA score on admission, lactate on admission and percentage of lung involvement on admission CTs, only SOFA score (OR 1.32, 95% CI 1.08–1.62) and lung involvement (OR 1.06, 95% CI 1.01–1.11) were significantly associated with subsequent ECMO allocation. Receiver operating characteristic (ROC) curves showed an area under the curve (AUC) of 0.83 (95% CI 0.73–0.94) for lung involvement on admission CT and 0.82 (95% CI 0.72–0.91) for SOFA scores on ICU admission. A combined parameter of SOFA on ICU admission and lung involvement on admission CT yielded an AUC of 0.91 (0.84–0.97) with a sensitivity of 0.93 and a specificity of 0.84 for ECMO prediction; (4) Conclusions: AI-based assessment of lung involvement on CT scans on admission to the hospital and SOFA scoring, especially if combined, can be used as risk stratification tools for subsequent requirement for ECMO therapy in patients with severe COVID-19 disease to improve resource management in ICU settings.https://www.mdpi.com/2075-4418/11/6/1029COVID-19respiratory distress syndromeextracorporeal membrane oxygenationartificial intelligencecomputed tomography scan |
| spellingShingle | Eva Gresser Jakob Reich Bastian O. Sabel Wolfgang G. Kunz Matthias P. Fabritius Johannes Rübenthaler Michael Ingrisch Dietmar Wassilowsky Michael Irlbeck Jens Ricke Daniel Puhr-Westerheide Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission Diagnostics COVID-19 respiratory distress syndrome extracorporeal membrane oxygenation artificial intelligence computed tomography scan |
| title | Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission |
| title_full | Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission |
| title_fullStr | Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission |
| title_full_unstemmed | Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission |
| title_short | Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission |
| title_sort | risk stratification for ecmo requirement in covid 19 icu patients using quantitative imaging features in ct scans on admission |
| topic | COVID-19 respiratory distress syndrome extracorporeal membrane oxygenation artificial intelligence computed tomography scan |
| url | https://www.mdpi.com/2075-4418/11/6/1029 |
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