Searching for Infectious Foci in Intensive Care Patients: Diagnostic Yield of Computed Tomography and Prognostic Value of Clinical and Laboratory Chemical Parameters

TL;DR

Computed tomography is effective for detecting infections in ICU patients, especially in the chest, and certain conditions like asthma or diabetes may increase the likelihood of finding infectious foci.

Contribution

The study evaluates the diagnostic yield of CT and the prognostic value of clinical and lab parameters in ICU patients with suspected infections.

Findings

CT scans identified 147 inflammatory foci in 99 ICU patients, with 58.5% receiving definitive diagnoses.

Patients with bronchial asthma or type 2 diabetes had fewer CT-detected foci, suggesting a need for earlier suspicion of infection in these groups.

Abstract

Background/Objectives: Radiological imaging is crucial in intensive care settings, particularly for the differential diagnosis of fever and sepsis. Computed tomography (CT) is the preferred method for detecting infectious foci in critically ill ICU patients. Methods: This study prospectively analyzed non-ECG-gated chest and abdominal CT scans from ICU patients to assess CT’s diagnostic utility. Data from prior imaging modalities (CT, radiography, MRI, ultrasound), microbiological assays (blood cultures, bronchoalveolar lavage, urinalysis), and enzymatic profiles (transaminases, pancreatic enzymes) were included. The predictive value of clinical and laboratory parameters was evaluated via correlation analysis. Results: A total of 112 patients were evaluated, with 99 exhibiting 147 inflammatory foci (92 thoracic, 55 abdominal). Definitive diagnoses were made in 58.5% of cases, while 41.5% remained classified as possible. Prior diagnostic procedures identified inflammatory origins in 57.1% of cases. Fewer CT-detected foci were observed in patients with bronchial asthma or type 2 diabetes mellitus (p = 0.049 and p = 0.006). Conclusions: CT imaging plays a central role in identifying infectious foci in ICU patients with unexplained syndromes, particularly in the thoracic region. CT scanning is recommended for sepsis management when other diagnostic evidence is lacking. Conditions such as bronchial asthma or diabetes mellitus may prompt earlier suspicion of infectious foci due to elevated inflammatory markers.

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