期刊
RESPIRATORY MEDICINE
卷 102, 期 7, 页码 956-961出版社
W B SAUNDERS CO LTD
DOI: 10.1016/j.rmed.2008.02.016
关键词
extravascular lung water index; severe sepsis; medical ICU; transpulmonary thermodilution; survival
Background: This study was designated to investigate whether extravascular Lung water index (EVLI) is an independent predictor for mortality outcome in patients with severe sepsis. Methods: This study prospectively recruited patients with severe sepsis from a medical intensive care unit (ICU) at a university affiliated hospital. In each patient, transpulmonary thermodilution was used to measure cardiovascular hemodynamics and EVLI via an arterial catheter placed within 48 h of the patient meeting the criteria for severe sepsis. Results: In total, 33 patients were studied. EVLI, Acute Physiology and Chronic Health Evaluation (APACHE) II score, development of acute respiratory distress syndrome, chest X-ray score, lung injury score, body mass index, prior 24 h fluid balance, albumin, and white blood cell counts were shown to be predictors of in-hospital survival by a bivariate analysis. In multinominal logistic regression, EVLI (adjusted odds ratio, 6.21; p = 0.01; 95% confidence interval, 1.05-1.44) acted as an independent predictor for in-hospital survival. A cut-off value for EVLI of 10 ml/kg had good sensitivity (88.2%) and specificity (68.7%) by ROC curve analysis. Medical ICU patients with extremely severe sepsis and a high EVLI (>= 10ml/kg) had lower in-hospital survival rate than those with a low EVLI (< 10ml/kg) (15% vs. 67.7%, respectively, p < 0.001. Conclusions: This investigation suggested that EVLI was an independent predictor for in-hospital survival in medical ICU patients with severe sepsis. Measurement of EVLI may be used for risk stratification among those patients. (c) 2008 Elsevier Ltd. All rights reserved.
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