| Autor: |
Peng KW; Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City 333, Taiwan., Chang ML; Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City 333, Taiwan., Chien RN; Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City 333, Taiwan., Chen YC; Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan 333, Taiwan., Tian YC; Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan 333, Taiwan., Peng YS; Department of Internal Medicine, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan., Huang HC; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veteran General Hospital, Faculty of Medicine, Yang-Ming University School of Medicine, Taipei 112, Taiwan.; Division of General Medicine, Department of Medicine, Taipei Veteran General Hospital, Faculty of Medicine, Yang-Ming University School of Medicine, Taipei 112, Taiwan., Fang JT; Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan 333, Taiwan., Lee FY; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veteran General Hospital, Faculty of Medicine, Yang-Ming University School of Medicine, Taipei 112, Taiwan., Yang CW; Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan 333, Taiwan., Tsai MH; Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City 333, Taiwan. |
| Abstrakt: |
Backgrounds and Aims : Patients with cirrhosis are susceptible to sepsis and septic shock. Cirrhotic patients also have increased capillary permeability and are prone to developing volume overload. Patients with septic shock may have an enhanced pulmonary vascular permeability index (PVPI) and extravascular lung water index (EVLWI), both of which are associated with an unfavorable prognosis. It is plausible that pre-existing hyperpermeability may deteriorate when cirrhotic patients develop septic shock. However, it remains unknown whether PVPI and EVLWI can predict the prognosis of cirrhotic patients with septic shock. Pulse Indicator Continuous Cardiac Output (PiCCO) is an established tool to measure PVPI and EVLWI. Therefore, we conducted this retrospective study to investigate the prognostic significance of PVPI and EVLWI in cirrhotic patients with septic shock using PiCCO monitoring. Methods : We included 83 patients with liver cirrhosis and septic shock. EVLW indexed to actual body weight (aEVLWI), EVLW indexed to predicted body weight (pEVLWI), PVPI, disease severity scores, and other biomarkers were analyzed. We collected the PiCCO data on the first 2 days. Results : The overall 28-day mortality was 43.4%. The values of PVPI, aEVLWI, and pEVLWI on day 2 (PVPID2, aEVLWID2, EVLWID2) were significantly higher in non-survivors. The discriminating power of PVPID2 and EVLWID2 to predict 28-day mortality was tested using the area under a ROC curve. The areas under ROC curves (mean ± SEM) were 0.713 ± 0.061 and 0.650 ± 0.063 for PVPID2 and pEVLWID2. In the multivariate analysis, PVPID2, bilirubin, and lactate were independent factors which predicted 28-day mortality. Conclusions : Higher levels of PVPID2 and pEVLWID2 are associated with higher 28-day mortality rates in cirrhotic patients with septic shock. PVPI and pEVLWI may be useful to guide fluid management in this clinical setting. |
