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Clinical evaluation of acute lung injury in patients with severe pneumonia after radiotherapy: A respiratory system perspective
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Q. Zhu   , G. Zhou , S. Wan , S. Jiang , J. Jiang , F. Shen , Q. Wang |
| Department of Emergency Medicine, The First People's Hospital of Jiashan, Jiashan, Zhejiang Province, China , w683507@163.com |
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Abstract: (5 Views) |
Background: Acute lung injury (ALI) in patients with severe pneumonia after thoracic radiotherapy is a clinical problem, because infectious infiltrates may overlap radiation-induced lung changes. The present study aimed to investigate the clinical characteristics, radiological findings, inflammatory markers and outcomes in this population. Materials and Methods: A prospective observational study of 68 adults with severe pneumonia, prior thoracic radiotherapy, and concurrent ALI at a tertiary teaching hospital from January to December 2024. ALI severity was classified using PaO2/FiO2 ratios according to the Berlin definition. Clinical variables, inflammatory markers, chest imaging findings, respiratory-support requirements, intensive care unit (ICU) admission and in-hospital mortality were evaluated. Results: Mild, moderate and severe ALI was seen in 45.6%, 47.0% and 7.3% of patients respectively. Radiation and organizing pneumonia patterns of fibrosis were observed in 32.4% and 20.6% of patients, respectively. Mean C-reactive protein concentrations were higher in patients with consolidation (129.2 mg/L), patchy opacities (124.4 mg/L) and lower in patients with radiation fibrosis (78.3 mg/L). ICU admission was required in 50% of patients and invasive mechanical ventilation in 45.6%. In-hospital mortality was 25.0% overall. None of the predictors evaluated were statistically significant in the multivariate mortality model. Conclusion: Severe pneumonia with ALI after thoracic radiotherapy is associated with overlapping infectious and radiation-related radiological findings, substantial critical-care requirements, and substantial in-hospital mortality. Early recognition and integrated assessment of oxygenation, inflammatory markers and imaging findings may support clinical risk stratification. |
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| Keywords: Acute lung injury (ALI), radiation pneumonitis, severe pneumonia, radiotherapy, inflammatory markers, ICU outcomes. |
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Subject:
Radiation Biology
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