RESUMEN
Pulmonary hypertension [PH] is a significant cause of morbidity and mortality in patients suffering from pulmonary parenchymal diseases. Diagnosis of PH has always been a major clinical dilemma due to its non-specific clinical manifestations. However, diagnosing PH and determining its severity are essential for the prognosis and treatment planning in PH patients. This study aimed at evaluating the correlation between the pulmonary artery diameter [PAD] in the CT-scan and pulmonary artery pressure [PAP] in echocardiography of patients. PAD was evaluated in the CT-scan of 117 patients suffering from interstitial lung disease [ILD] and the correlation between PAD and PAP was studied. A receiver operating characteristic curve [ROC curve] which is indicative of the precision of the diagnostic test was drawn to find the cut off point for the MPAD representing PH. The area under the curve was also calculated in order to define the discriminative power of the test. PAP higher than 25 mmHg was considered as PH. PAD over 29 mm reported in the CT-scan for the diagnosis of PH in ILD patients had sensitivity of 63% and specificity of 41.5%. No significant linear correlation was found between PAD and PAP [P-value=0.17, r=0.15]. The area under the ROC curve was calculated to be 0.49 in the cutoff point of 29 mm for determining PH [CI 95%=0.38-0.60, P=0.89]. ROC curve showed a weak discriminative power. PAD had low sensitivity and specificity in the CT-scan for the diagnosis of PH. Therefore, we conclude that CT-scan alone is not helpful in finding PH cases and further examinations are required
RESUMEN
The aim of this study is to compare the performance of five applied general severity scoring systems and their ability to predict mortality rate for the intensive care unit patients: Simplified Acute Physiology Score II [SAPS II], Mortality Probability Model II at admission [MPM II[0]], at 24 hours [MPM II[24]], at 48 hours [MPM II[48]] and over time [MPM II[over time]]. These scoring systems have been developed in response to an increased emphasis on the evaluation and monitoring of health care services; and also making cost-effective decisions. In this historical cohort study, all of the scoring systems were applied to 114 patients and the predicted mortality rate and the Standardized Mortality Ratio [SMR] were calculated for them. Calibration of each model and discriminative powers were evaluated by using Hosmer-Lemeshow goodness of fit test and ROC curve analysis, respectively. The predicted mortalities were not significantly deviated from the main systems [SMR for SAPS II: 0.79, MPM II[0]: 1.10, MPM II[24]: 1.32, MPM II[48]: 1.08 and MPM[Over time]: 1.02]. The Hosmer-Lemeshow statistics had the least value for MPM II[48] [C=2.922, p-value=0.939]; and the discrimination was best for MPM II[24] [AUC=0.927] followed by SAPS II [AUC=0.903], MPM II[0] [AUC=0.899], MPM II[48] [AUC=0.848] and MPM II[over time] [AUC=0.861]. All five general ICU morality predictors showed accurate standardized mortality ratio. MPM II[24] had the best discrimination, MPM II[0] had the best SMR before 24 hours and MPM[over time] had the best SMR after 24 hours. Performance of MPM II and its ease of use make it an efficient model for mortality prediction in our study