Journal article
Superimposed Pressure Predicts Mortality in Acute Respiratory Failure during Spontaneous Breathing: insights from the CT-COVID19 multicenter study group
CHEST critical care, 100231
01/08/2026
DOI: 10.1016/j.chstcc.2025.100231
Abstract
Early lung imaging may improve patient management and prognostication in acute respiratory failure.
We aimed to explore whether quantitative assessment of lung injury by computed tomography (CT) predicts outcome in spontaneously breathing patients with COVID-19 acute respiratory failure.
This is a large retrospective, multicenter, cohort study including patients presenting to the Emergency Department with a clinical diagnosis of COVID-19 respiratory failure and undergoing early lung CT scan at hospital admission. Lung injury was characterized by the severity of lung involvement as follows: 1) absence, unilateral, or bilateral infiltrates; 2) number of lung quadrants affected by infiltrates (0-4); level of global and regional 3) superimposed pressure (SP) and 4) gas/tissue ratio (G/T). Baseline, laboratory and clinical characteristics were described by the presence or absence of laterality of lung infiltrates. Association of 90-day mortality and lung CT characterization was explored using Cox multivariable models and areas under receiving operating characteristics. Subphenotypes including CT assessment were explored by latent class analyses.
Eight-hundred and eight patients were included. Bilateral infiltrates were associated with higher global and regional SP and G/T and a higher 90-day mortality (38%) compared with unilateral infiltrates (18%) or no lung infiltrates (11%). Involvement by laterality, quadrants, degree of global SP and G/T were all associated with the degree of hypoxemia on admission and 90-day mortality. Among other CT-derived variables of lung injury, SP characterized a subphenotype with a robust relationship with 90-day mortality.
Characterization of lung injury severity by early lung CT describes the severity of hypoxemia. The adjunct of CT global SP to clinical and laboratory parameters identified a subphenotype with high 90-day mortality prediction. Early lung CT may enhance population enrichment and improve prognostication in non-intubated patients with acute respiratory failure.
Details
- Title: Subtitle
- Superimposed Pressure Predicts Mortality in Acute Respiratory Failure during Spontaneous Breathing: insights from the CT-COVID19 multicenter study group
- Creators
- Emanuele Rezoagli - University of Milano-BicoccaDavide Signori - Department of Anesthesia and Intensive Care, ASST-Bergamoest, Seriate, ItalyYi Xin - Harvard Medical SchoolSarah Gerard - University of IowaAurora Magliocca - Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, ItalyFrancesca Graziano - University of Milano-BicoccaGiovanni Vitale - Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, ItalyLinda Mussoni - Istituto per la Sicurezza Sociale, San Marino, San MarinoJonathan Montomoli - Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Romagna, Rimini, ItalyMatteo Subert - MylanAlessandra Ponti - Aziende Socio Sanitarie Territoriali di LeccoSavino Spadaro - Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Ferrara, Ferrara, ItalyGiancarla Poli - Department of Anaesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, ItalyFrancesco Casola - Harvard UniversityRoberta Garberi - University of Milano-BicoccaDavide Raimondi Cominesi - University of Milano-BicoccaAlice Nova - University of Milano-BicoccaMarco Giani - University of Milano-BicoccaGiuseppe Foti - University of Milano-BicoccaJohn Laffey - Ollscoil na Gaillimhe – University of GalwayMaurizio Cereda - Harvard Medical SchoolMatteo Cazzaniga - Department of Anaesthesia and Critical Care Medicine & Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, ItalyFerdinando Luca Lorini - Department of Anaesthesia and Critical Care Medicine & Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, ItalyPietro Bonaffini - Department of Anaesthesia and Critical Care Medicine & Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, ItalyIrene Ottaviani - University of FerraraAsia Borgo - Aziende Socio Sanitarie Territoriali di LeccoMario Tavola - Aziende Socio Sanitarie Territoriali di LeccoLivio Ferraris - Department of Anesthesia and Intensive Care Medicine, Melzo-Gorgonzola Hospital, Azienda Socio-Sanitaria Territoriale Melegnano e della Martesana, Melegnano, Milan, ItalyGiacomo Bellani - Department of Emergency and Intensive Care, & Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, ItalyStefano Gatti - Department of Emergency and Intensive Care, & Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, ItalyAndrea Restivo - Department of Emergency and Intensive Care, & Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, ItalyFilippo Serra - Department of Emergency and Intensive Care, & Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, ItalyDavide Ippolito - Department of Emergency and Intensive Care, & Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, ItalyMassimo Arlotti - Istituto per la Sicurezza Sociale, San Marino, San MarinoMarino Gatti - Istituto per la Sicurezza Sociale, San Marino, San MarinoBeatrice Tamagnini - Istituto per la Sicurezza Sociale, San Marino, San MarinoEnrico Cavagna - Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Romagna, Rimini, ItalyEmiliano Gamberini - Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Romagna, Rimini, ItalyDavide De Ponti - Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, ItalyGiuseppe Galbiati - Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, ItalyMatteo Giacomini - Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, ItalyCT-COVID19 Multicenter Study Group
- Resource Type
- Journal article
- Publication Details
- CHEST critical care, 100231
- DOI
- 10.1016/j.chstcc.2025.100231
- ISSN
- 2949-7884
- eISSN
- 2949-7884
- Publisher
- Elsevier Inc
- Language
- English
- Electronic publication date
- 01/08/2026
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9985121498502771
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