Association between changes in disease severity and physical function after surviving a critical illness: A multicentre retrospective observational study.

BACKGROUND: Whilst disease severity can significantly impact functional outcomes, the ability to predict the scale of this impact has not been consistent. AIM: We aimed to investigate whether changes in disease severity within the first 48 h of ICU admission are more strongly associated with physical dysfunction than a single-time assessment of disease severity at ICU admission. METHODS: A multicentre retrospective study in seven tertiary ICUs in Japan, including all consecutive adult ICU patients (>48 h ICU stay) between September 2019 and February 2020. The primary outcome was physical function defined as the Barthel Index, which is an ordinal scale (0-100: larger indicates better function) to measure physical independence and performance. The association between Barthel Index score at hospital discharge and the Sequential Organ Failure Assessment (SOFA) scores, measured at ICU admission, the highest recorded score within 48 h of ICU admission, and the level of change between these two timepoints were investigated in multivariable analysis. RESULTS: A total of 199 patients were included. Median SOFA score at ICU admission and the highest recorded score within the first 48 h were 6 (interquartile range: 5-10) and 8 (interquartile range: 6-11), respectively. A quarter of patients had a Barthel Index score of 60 or less at hospital discharge. The highest SOFA score within 48 h of ICU admission and the level of change in SOFA scores between ICU admission and the highest recorded score within 48 h were significantly associated with lower Barthel Index scores at hospital discharge. No significant association was identified with regard to Barthel Index scores and SOFA score at ICU admission. An increase in SOFA score of 1 or more within the first 48 h of ICU admission was the threshold to predict a Barthel Index score of 60 or less at hospital discharge. Larger changes in SOFA scores over the first 48 h of ICU admission were also significantly associated with smaller changes in Barthel Index scores from ICU discharge to hospital discharge. CONCLUSIONS: The level of change in SOFA score between ICU admission and the highest recorded score within the first 48 h of ICU stay can more accurately predict the presence of physical dysfunction at hospital discharge than a single-time assessment of disease severity at ICU admission. The larger worsening in SOFA potentially indicates lower recovery after a critical illness.

Noninvasive Computed Tomography-Derived Fractional Flow Reserve Based on Structural and Fluid Analysis: Reproducibility of On-site Determination by Unexperienced Observers.

OBJECTIVE: The aim of this study was to evaluate the reproducibility of computed tomography (CT)-derived fractional flow reserve (FFR) determined on site by inexperienced observers using a postprocessing software based on structural and fluid analysis. METHODS: Using 21 coronary vessels in 7 patients who underwent 320-row coronary CT angiography and catheter-FFR, 2 independent inexperienced observers (A: a student radiation technologist; B: a nonmedical staff) determined the CT-FFR using a postprocessing software. After a 20-minute training session, both observers postprocessed all vessels and readjusted their settings after another training/feedback. These CT-FFRs were compared with values determined by an expert analyst. RESULTS: The mean processing times were 23 ± 4 minutes (automatic), 71 ± 5 minutes (observer A), and 57 ± 7 minutes (observer B) per patient. The initial correlations with expert data were r = 0.92 (observer A) and 0.73 (observer B) and increased to 0.83 for observer B after additional training. The final absolute difference with the expert data was 0.000 to 0.020. The correlation between catheter-FFR and expert CT-FFR was r = 0.76. CONCLUSIONS: The CT-derived FFR on-site postprocessing software showed good reproducibility for measurements by inexperienced observers.

Diagnostic performance of on-site computed CT-fractional flow reserve based on fluid structure interactions: comparison with invasive fractional flow reserve and instantaneous wave-free ratio.

AIMS: We evaluated diagnostic accuracy of CT-fractional flow reserve (CT-FFR) computed on-site with a new vendor workstation, against invasive FFR as the reference standard. METHODS AND RESULTS: Retrospective analyses compared CT-FFR of 104 vessels with 30-90% diameter stenosis in 75 patients imaged using single-rotation 320 detector-row coronary CT angiography (CCTA) with invasive FFR performed within 90 days. Prospective ECG-gated CCTA included exposure of 70-99% of the R-R interval. CT-FFR was computed on-site within the same physical space as the CT scanner and reading room. The diagnostic accuracy of CCTA >50% and CT-FFR ≤0.8 to detect hemodynamically significant stenosis, defined as FFR ≤0.8, was determined, as was the correlation of CT-FFR to FFR and instantaneous wave-free ratio (iFR). Forty-four vessels (42.3%) had an invasive FFR ≤0.8. The sensitivity, specificity, positive, and negative predictive value of CT-FFR ≤0.8 vs. CCTA >50% to detect hemodynamically significant stenosis defined as FFR ≤0.8 were 90.9% vs. 70.5%, 78.3% vs. 43.3%, 75.5% vs. 47.7%, and 92.2% vs. 66.7%, respectively. Area under the curve of CT-FFR was significantly higher than CCTA >50% [0.85, 95% confidence interval (CI): 0.76-0.91 vs. 0.57, 95% CI: 0.47-0.67; P < 0.0001]. The correlation coefficient between CT-FFR and iFR was r = 0.62 (95% CI: 0.40-0.77, P < 0.0001) and that between CT-FFR and invasive FFR was r = 0.52 (95% CI: 0.28-0.70, P = 0.0001). CT-FFR inter- and intra-observer correlations were excellent (r = 0.83 and r = 0.82, respectively). CONCLUSION: Locally computed CT-FFR based on fluid structure interaction has excellent diagnostic accuracy to detect a significant FFR ≤0.8 compared with conventional CCTA and high reproducibility.