[Early predictive value of hemodynamic parameters during fluid resuscitation in patients with sepsis shock]

Wei Chen, Xuefeng Zang, Suping Niu, Chao Lyu, Lei Zhao, Bo Sheng, Xuyun Gu, Jingshu Zhang
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015, 27 (1): 43-7

OBJECTIVE: To investigate the short term predictive value of hemodynamic parameters during fluid resuscitation in patients with septic shock.

METHODS: Data of 76 patients with septic shock admitted to Department of Critical Care Medicine of Beijing Shijitan Hospital from January 2013 to October 2014 were retrospectively analyzed. The hemodynamic parameters were monitored by pulse indicator continuous cardiac output ( PiCCO ), including mean arterial pressure ( MAP ), stroke volume index ( SVI ), cardiac index ( CI ), global ejection fraction ( GEF ), global end diastolic volume index ( GEDVI ), intrathoracic blood volume index ( ITBVI ), extravascular lung water index ( EVLWI ), systemic vascular resistance index ( SVRI ), and pulmonary vascular permeability index ( PVPI ). They were recorded before and 6 hours after fluid resuscitation. According to the prognosis on the 7th day, the patients were divided into survival group ( n = 42 ) and death group ( n = 34 ). The PiCCO records between two groups were compared and a receiver operating characteristic ( ROC ) curve for predicting the outcome was plotted to find the cut-off point value for each PiCCO record before and 6 hours after fluid resuscitation.The factors for predicting 7-day prognosis of patients with septic shock were analyzed by multivariate logistic regression analysis.

RESULTS: (1) Compared with those before fluid resuscitation, EVLWI and PVPI were significantly decreased at 6 hours after fluid resuscitation in the survival group [ EVLWI ( mL/kg ): 7.33±1.72 vs. 9.07±2.81, PVPI: 1.39±0.34 vs. 1.74±0.50, both P<0.01 ] but they were significantly increased in the death group [ EVLWI ( mL/kg ): 12.62±3.58 vs. 8.97±2.74, PVPI: 2.36±0.81 vs. 1.73±0.60, both P<0.01 ], and MAP in the death group decreased after fluid resuscitation [ MAP ( mmHg, 1 mmHg = 0.133 kPa ): 70.53±12.12 vs. 77.06±13.48, P<0.01 ]. (2)ROC curve showed that the area under ROC curve ( AUC ) of EVLWI at 6 hours after fluid resuscitation was 0.914, cut-off value was 9.50 mL/kg, the sensitivity was 82.4% and the specificity was 88.1%. The AUC of PVPI was 0.890, when cut-off value was 1.75, the sensitivity was 73.5%, and the specificity was 92.9%. (3) It was shown by multivariate logistic regression analysis that only EVLWI at 6 hours after fluid resuscitation was an independent predictor for 7-day prognosis of septic patient [ odds ratio ( OR ) = 0.546, 95% confidence interval ( 95%CI ) = 0.852-0.976, P = 0.006 ].

CONCLUSIONS: PiCCO monitoring indicators such as EVLWI, PVPI and MAP have certain prognostic value for septic patients, but only EVLWI at 6 hours after fluid resuscitation is an independent prognostic factor for short term prognosis.

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