A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation.

Autor: Chandra J; Harvard College, Harvard University, Cambridge, MA, 02138, USA. jaychandra@college.harvard.edu., Armengol de la Hoz MA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.; Big Data Department, Fundación Progreso y Salud, Regional Ministry of Health of Andalucia, Sevilla, Spain., Lee G; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.; Harvard Kennedy School, Boston, MA, USA., Lee A; Harvard T.H. Chan School of Public Health, Boston, MA, USA., Thoral P; Intensive Care Unit, Amsterdam University Medical Center, Amsterdam, The Netherlands., Elbers P; Intensive Care Unit, Amsterdam University Medical Center, Amsterdam, The Netherlands., Lee HC; Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea., Munger JS; Division of Pulmonary, Critical Care and Sleep Medicine, NYU School of Medicine, New York, NY, USA., Celi LA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Kaufman DA; Division of Pulmonary, Critical Care and Sleep Medicine, NYU School of Medicine, New York, NY, USA.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2022 Apr 11; Vol. 26 (1), pp. 103. Date of Electronic Publication: 2022 Apr 11.
DOI: 10.1186/s13054-022-03968-4
Abstrakt: Purpose: Sepsis is a leading cause of morbidity and mortality worldwide and is characterized by vascular leak. Treatment for sepsis, specifically intravenous fluids, may worsen deterioration in the context of vascular leak. We therefore sought to quantify vascular leak in sepsis patients to guide fluid resuscitation.
Methods: We performed a retrospective cohort study of sepsis patients in four ICU databases in North America, Europe, and Asia. We developed an intuitive vascular leak index (VLI) and explored the relationship between VLI and in-hospital death and fluid balance using generalized additive models (GAM).
Results: Using a GAM, we found that increased VLI is associated with an increased risk of in-hospital death. Patients with a VLI in the highest quartile (Q4), across the four datasets, had a 1.61-2.31 times increased odds of dying in the hospital compared to patients with a VLI in the lowest quartile (Q1). VLI Q2 and Q3 were also associated with increased odds of dying. The relationship between VLI, treated as a continuous variable, and in-hospital death and fluid balance was statistically significant in the three datasets with large sample sizes. Specifically, we observed that as VLI increased, there was increase in the risk for in-hospital death and 36-84 h fluid balance.
Conclusions: Our VLI identifies groups of patients who may be at higher risk for in-hospital death or for fluid accumulation. This relationship persisted in models developed to control for severity of illness and chronic comorbidities.
(© 2022. The Author(s).)
Databáze: MEDLINE
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