Impact of extravascular lung water index on outcomes of severe sepsis patients in a medical intensive care unit

Fu-Tsai Chung, Shu-Min Lin, Shinn-Yn Lin, Horng-Chyuan Lin
Respiratory Medicine 2008, 102 (7): 956-61

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 48h 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 24h 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 10ml/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 (> or =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.

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