Diagnostic and Prognostic Value of Quantitative Computed Tomography Parameters of Adrenal Glands in Patients from Internistled ICU with Sepsis and Septic Shock

Abstract

The aim was to prospectively evaluate the diagnostic and prognostic value of different quantitative analysis methods assessing adrenal gland parameters on contrast-enhanced CT scans in patients with septic conditions. Seventy–six patients (49 men, 27 women) received CT scans for focus search. Adrenal glands were analyzed by means of three different methods: subjective region of interest (ROI) measurement, organ segmentation and histogram analysis using semi-automated software. Univariate analyses with multiple testing thresholds and receiver operating characteristic curves were performed. Clinical endpoints were 8-days, 28-days and 6-months mortality. Forty-four CT scans were analyzed (ground truth: patients with no sepsis: n = 6; patients with sepsis: n = 15; patients in septic shock: n = 21). Left adrenal gland (LAG) values were analyzed and compared, as data variation was lower than in the right adrenal glands. In patients with septic conditions, the combination of high LAG and Inferior Vena Cava (IVC) density values was highly specific for septic shock with all three methods. Only segmentation values were significantly different between the sepsis and septic shock groups after confounder correction (p = 0.048). Total adrenal gland volume was 20% higher in the septic shock patients while a relatively small LAG volume within the septic shock subgroup was associated with higher mortality at day 8 (AUC = 0.8; p = 0.006) and at 6 months (AUC = 0.7; p = 0.035). However, time-consuming density analysis methods assessing adrenal glands do not provide additional diagnostic value in patients with septic conditions. The combination of high LAG and IVC attenuation values seems to be highly specific for septic shock, regardless of the analysis type. Adrenal gland volume reveals short- and long-term prognostic capacity.