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Adrenal heterogeneity in the arterial phase of contrast-enhanced CT predicts prognosis in septic shock: comparison with hollow adrenal gland sign

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Abstract

Purpose

To evaluate the prognostic value of adrenal heterogeneity in the arterial phase in patients with septic shock, comparatively to the hollow adrenal gland sign (HAGS).

Methods

Totally 84 consecutive patients with septic shock (group S) were assessed retrospectively, and abdominal dual-phase contrast-enhanced CT was performed after the diagnosis of septic shock within one week. The patients were divided into two groups according to clinical outcome, including the survivor (group A, 41 cases) and death (group B, 43 cases) groups. Fifty negative cases were matched as the control (group C). The incidence of the HAGS in patients with septic shock (group S) was statistically analyzed. The average values of left adrenal density (Den-A and Den-V) and their standard deviations (SDDen-A and SDDen-V) in dual phases were measured. The above parameters were compared between groups A and B as well as with group C. The parameters were assessed for their predictive values of mortality in septic shock, comparatively to the HAGS.

Results

Compared with group C, group S presented significantly higher Den-A (P = 0.003) and SDDen-A (P < 0.001). There were significantly higher SDDen-A (P < 0.001) in group B compared with group A. The incidence of the HAGS was about 27.4% (23/84) in group S. The sensitivity and specificity in predicting poor prognosis in patients with septic shock were 78% and 85% with SDDen-A, at a cut-off value of 28.64, respectively. The sensitivity and specificity were 41% and 88% for the HAGS, respectively. The area under ROC curve (AUC) was significantly greater for SDDen-A compared with the HAGS (0.820 vs. 0.670, P < 0.001).

Conclusion

Adrenal heterogeneity in the arterial phase can predict prognosis in patients with septic shock; the larger the SDDen-A, the poorer the prognosis. The predictive efficiency of adrenal heterogeneity in the arterial phase is better than the HAGS.

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Abbreviations

ICU:

Intensive care unit

HAGS:

Hollow adrenal gland sign

SD:

Standard deviation

ROC:

Receiver operating characteristic

AUC:

Area under ROC curve

ICC:

Intraclass correlation coefficient

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Funding

No funding was received to assist with the preparation of this manuscript.

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Author notes

  1. Guanglei Tang and Ke Wang contributed equally to this work, and they are co-first authors.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshanerlu Road, Guangzhou, Guangdong, People’s Republic of China

    Guanglei Tang, Ke Wang, Yang Peng, Mengya Sun & Jian Guan

  2. Clinical Science, Philips Healthcare China, No. 718 Lingshi Road, Shanghai, People’s Republic of China

    Weiwei Deng

Authors
  1. Guanglei Tang
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  2. Ke Wang
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  3. Yang Peng
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  4. Mengya Sun
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  5. Weiwei Deng
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  6. Jian Guan
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Contributions

Conceptualization: YP, JG; Methodology: GT, KW, MS, WD; Formal analysis and investigation: GT, KW, WD, MS; Writing—original draft preparation: GT, KW; Writing—review and editing: JG; Supervision: YP, JG. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jian Guan.

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The authors declare that they have no conflicts of interest.

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Approval was granted by the Ethics Committee of The First Affiliated Hospital, Sun Yat-Sen University.

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Informed consent was obtained from all individual participants included in the study.

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Tang, G., Wang, K., Peng, Y. et al. Adrenal heterogeneity in the arterial phase of contrast-enhanced CT predicts prognosis in septic shock: comparison with hollow adrenal gland sign. Jpn J Radiol 41, 92–97 (2023). https://doi.org/10.1007/s11604-022-01324-8

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  • DOI: https://doi.org/10.1007/s11604-022-01324-8

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