Value of chest high-resolution CT score in severity assessment of hip fracture-induced early acute lung injury in elderly patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Xi ¹ , LIU Lei ² , YANG Hua ¹ , ZHANG Qin ¹ , TIAN Li ¹ , ZHANG Dechuan ¹ , YANG Huiping ¹ ,  MA Huixu ³

1. Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, P.R.China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
3. Department of Orthopedic Trauma, Chongqing General Hospital, Chongqing, 400011, P.R.China;

Corresponding author：

MA Huixu, Email: mahuixu@aliyun.com

Keywords：

High resolution computer tomography; acute lung injury; quantitative analysis; hip fracture; elderly patients

DOI：

10.7507/1007-4848.202006030

Video：

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Objective To investigate the value of chest high-resolution computed tomography (HRCT) score in evaluating the severity of hip fracture-induced early acute lung injury (ALI) in the elderly patients.Methods The clinical data of 289 elderly hip fracture patients in Chongqing Traditional Chinese Medicine Hospital from July 2014 to April 2020 were retrospectively analyzed. All patients were divided into two groups, including an ALI group (n=114, 36 males and 78 females at age of 82.94±6.85 years) and a non-ALI group (n=175, 51 males and 124 females at age of 84.42±6.31 years). General information, chest HRCT scores and PaO₂/FiO₂ were compared between the two groups. Correlation analysis was used to compare the relationship between chest HRCT scores and PaO₂/FiO₂. Multiple linear stepwise regression analysis was applied to evaluate the effective extent of the diffuse ground glass opacity (DGGO), intense parenchymal opacification (IPO), and reticulation HRCT scores to the overall HRCT scores.Results The DGGO scores, IPO scores, reticulation scores, overall HRCT scores and PaO₂/FiO₂ were higher in the ALI group than those in the non-ALI group (P<0.001). In the ALI group, correlation analysis showed that DGGO, overall HRCT scores were in significantly negative correlation with PaO₂/FiO₂ (P<0.001). In addition, the correlation among PaO₂/FiO₂ and overall HRCT scores was more significant than that of DGGO scores. Multiple stepwise regression analysis indicated that DGGO, IPO, and reticulation scores were independent influencing factors for overall HRCT scores. Among the influencing factors, DGGO scores had the greatest impact, then IPO scores and reticulation scores. The HRCT signs of DGGO, IPO, and reticulation appeared simultaneously had the greatest effects on the overall HRCT scores.Conclusion The chest HRCT score, which is associated with PaO₂/FiO₂, also can be used in the severity assessment of elderly patients with early ALI caused by hip fracture.

Citation： LIU Xi, LIU Lei, YANG Hua, ZHANG Qin, TIAN Li, ZHANG Dechuan, YANG Huiping, MA Huixu. Value of chest high-resolution CT score in severity assessment of hip fracture-induced early acute lung injury in elderly patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(6): 714-719. doi: 10.7507/1007-4848.202006030 Copy

1.	Anagnostis P, Paschou SA, Goulis DG. Management of acute hip fracture. N Engl J Med, 2018, 378(10): 971-972.
2.	赵小丹, 刘浩, 李涛, 等. 乌司他丁减轻老年大鼠髋部骨折后肺损伤程度的实验研究. 四川大学学报(医学版), 2017, 48(6): 869-872.
3.	Gan L, Chen X, Sun T, et al. Significance of serum mtDNA concentration in lung injury induced by hip fracture. Shock, 2015, 44(1): 52-57.
4.	Huang XF, Xiu HQ, Zhang SF, et al. The role of macrophages in the pathogenesis of ALI/ARDS. Mediators Inflamm, 2018, 2018: 1-8.
5.	徐轩, 王宏志, 董军, 等. 食管癌术后急性肺损伤/急性呼吸窘迫综合征的危险因素分析. 北京大学学报(医学版), 2018, 50(6): 1057-1062.
6.	Caltabeloti F, Monsel A, Arbelot C, et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care, 2014, 18(3): R91.
7.	Helen L, Abid R. Acute lung injury and acute respiratory distress syndrome: A review article. BJMP, 2010, 3(2): 33-39.
8.	中华医学会重症医学分会. 急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006). 中国危重病急救医学, 2006, 18(12): 706-710.
9.	Burnham EL, Hyzy RC, Paine R, et al. Chest CT features are associated with poorer quality of life in acute lung injury survivors. Crit Care Med, 2013, 41(2): 445-456.
10.	Ma Y, Zhang S, Zhao L, et al. Inhalation lung injury induced by smoke bombs in children: CT manifestations, dynamic evolution features and quantitative analysis. J Thorac Dis, 2018, 10(10): 5860-5869.
11.	Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
12.	张鹏, 盛晓磊, 单冰晨, 等. 大坪骨科老年手术风险评分系统评分对老年髋部骨折患者术后实施分层救治的临床意义. 中华创伤杂志, 2020, 36(1): 45-50.
13.	Haleem S, Lutchman L, Mayahi R, et al. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury, 2008, 39(10): 1157-1163.
14.	Tan STS, Tan WPM, Jaipaul J, et al. Clinical outcomes and hospital length of stay in 2, 756 elderly patients with hip fractures: A comparison of surgical and nonsurgical management. Singapore Med J, 2017, 58(5): 253-257.
15.	Dick AG, Davenport D, Bansal M, et al. Hip fractures in centenarians: Has care improved in the national hip fracture database era? Geriatr Orthop Surg Rehabil, 2017, 8(3): 161-165.
16.	Gan L, Sun T, Li B, et al. Serum miR-146a and miR-150 as potential new biomarkers for hip fracture-induced acute lung injury. Mediators Inflamm, 2018, 2018: 8101359.
17.	Zhang JZ, Wang J, Qu WC, et al. Plasma mitochondrial DNA levels were independently associated with lung injury in elderly hip fracture patients. Injury, 2017, 48(2): 454-459.
18.	Yu XJ, Chen XB, Sun TS, et al. MicroRNA-205-5p targets HMGB1 to suppress inflammatory responses during lung injury after hip fracture. Biomed Res Int, 2019, 2019: 1-13.
19.	Johnson ER, Matthay MA. Acute lung injury and the acute respiratory distress syndrome: Pathophysiology and treatment. J Aerosol Med Pulm Drug Deliv, 2010, 23(4): 243-252.
20.	杨志辉, 许永明, 江晓勇, 等. 急性硫化氢中毒肺损伤CT评分与氧合指数相关性研究. 中华劳动卫生职业病杂志, 2017, 35(9): 691-694.
21.	Lee HJ, Im JG, Goo JM, et al. Acute lung injury: effects of prone positioning on cephalocaudal distribution of lung inflation-CT assessment in dogs. Radiology, 2005, 234(1): 151-161.
22.	Artunduaga M, Rao D, Friedman J, et al. Pediatric chest radiographic and CT findings of electronic cigarette or vaping product use-associated lung injury (EVALI). Radiology, 2020, 295(2): 430-438.

1. Anagnostis P, Paschou SA, Goulis DG. Management of acute hip fracture. N Engl J Med, 2018, 378(10): 971-972.
2. 赵小丹, 刘浩, 李涛, 等. 乌司他丁减轻老年大鼠髋部骨折后肺损伤程度的实验研究. 四川大学学报(医学版), 2017, 48(6): 869-872.
3. Gan L, Chen X, Sun T, et al. Significance of serum mtDNA concentration in lung injury induced by hip fracture. Shock, 2015, 44(1): 52-57.
4. Huang XF, Xiu HQ, Zhang SF, et al. The role of macrophages in the pathogenesis of ALI/ARDS. Mediators Inflamm, 2018, 2018: 1-8.
5. 徐轩, 王宏志, 董军, 等. 食管癌术后急性肺损伤/急性呼吸窘迫综合征的危险因素分析. 北京大学学报(医学版), 2018, 50(6): 1057-1062.
6. Caltabeloti F, Monsel A, Arbelot C, et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care, 2014, 18(3): R91.
7. Helen L, Abid R. Acute lung injury and acute respiratory distress syndrome: A review article. BJMP, 2010, 3(2): 33-39.
8. 中华医学会重症医学分会. 急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006). 中国危重病急救医学, 2006, 18(12): 706-710.
9. Burnham EL, Hyzy RC, Paine R, et al. Chest CT features are associated with poorer quality of life in acute lung injury survivors. Crit Care Med, 2013, 41(2): 445-456.
10. Ma Y, Zhang S, Zhao L, et al. Inhalation lung injury induced by smoke bombs in children: CT manifestations, dynamic evolution features and quantitative analysis. J Thorac Dis, 2018, 10(10): 5860-5869.
11. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
12. 张鹏, 盛晓磊, 单冰晨, 等. 大坪骨科老年手术风险评分系统评分对老年髋部骨折患者术后实施分层救治的临床意义. 中华创伤杂志, 2020, 36(1): 45-50.
13. Haleem S, Lutchman L, Mayahi R, et al. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury, 2008, 39(10): 1157-1163.
14. Tan STS, Tan WPM, Jaipaul J, et al. Clinical outcomes and hospital length of stay in 2, 756 elderly patients with hip fractures: A comparison of surgical and nonsurgical management. Singapore Med J, 2017, 58(5): 253-257.
15. Dick AG, Davenport D, Bansal M, et al. Hip fractures in centenarians: Has care improved in the national hip fracture database era? Geriatr Orthop Surg Rehabil, 2017, 8(3): 161-165.
16. Gan L, Sun T, Li B, et al. Serum miR-146a and miR-150 as potential new biomarkers for hip fracture-induced acute lung injury. Mediators Inflamm, 2018, 2018: 8101359.
17. Zhang JZ, Wang J, Qu WC, et al. Plasma mitochondrial DNA levels were independently associated with lung injury in elderly hip fracture patients. Injury, 2017, 48(2): 454-459.
18. Yu XJ, Chen XB, Sun TS, et al. MicroRNA-205-5p targets HMGB1 to suppress inflammatory responses during lung injury after hip fracture. Biomed Res Int, 2019, 2019: 1-13.
19. Johnson ER, Matthay MA. Acute lung injury and the acute respiratory distress syndrome: Pathophysiology and treatment. J Aerosol Med Pulm Drug Deliv, 2010, 23(4): 243-252.
20. 杨志辉, 许永明, 江晓勇, 等. 急性硫化氢中毒肺损伤CT评分与氧合指数相关性研究. 中华劳动卫生职业病杂志, 2017, 35(9): 691-694.
21. Lee HJ, Im JG, Goo JM, et al. Acute lung injury: effects of prone positioning on cephalocaudal distribution of lung inflation-CT assessment in dogs. Radiology, 2005, 234(1): 151-161.
22. Artunduaga M, Rao D, Friedman J, et al. Pediatric chest radiographic and CT findings of electronic cigarette or vaping product use-associated lung injury (EVALI). Radiology, 2020, 295(2): 430-438.

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Value of chest high-resolution CT score in severity assessment of hip fracture-induced early acute lung injury in elderly patients

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