Prediction of pulmonary edema by plasma protein levels in patients with sepsis
| Autor: | Zhongheng Zhang, Baolong Lu, Xiaoyan Sheng, Hongying Ni, Ni Jin |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Thermodilution Plasma Substitutes Cardiac index Urology Hemodynamics Pulmonary Edema Critical Care and Intensive Care Medicine Sepsis medicine Humans Prealbumin Aged Retrospective Studies chemistry.chemical_classification Septic shock business.industry Transferrin Albumin Blood Proteins Middle Aged Pulmonary edema medicine.disease Blood proteins Surgery chemistry Extravascular Lung Water Female business Biomarkers |
| Zdroj: | Journal of Critical Care. 27:623-629 |
| ISSN: | 0883-9441 |
| DOI: | 10.1016/j.jcrc.2012.08.007 |
| Popis: | Purpose: The difficulties of fluid therapy in patients with septic shock are to maintain sufficient vascular volume while preventing pulmonary edema formation. Thus, it is important to find a biomarker that can reliably predict pulmonary edema formation after fluid loading. We evaluated the association of plasma protein levels with the increase in extravascular lung water index (ΔEVLWI) after fluid loading. Methods: This was an observational study in which we retrospectively reviewed medical records of septic patients in whom hemodynamic variables were measured by transpulmonary thermodilution technique before and after fluid loading. Plasma protein levels were measured before fluid loading. Patients were divided into 2 groups according to the changes in EVLWI (ΔEVLWI ≥10%) after fluid loading. Diagnostic performance of plasma proteins in predicting pulmonary edema formation was assessed. Results:Atotal of 62patients were included, and 27ofthem showed a ΔEVLWI 10%or higherafter fluid loading. Plasma albumin and transferrin were significantly lower in this group than in the group with ΔEVLWI less than 10% (21.7 ± 5.8 vs 25.3 ± 5.0 g/L for albumin, P b .05; 107.9 ± 50.1 vs 136.8 ± 44.2 mg/dL for transferrin, P b .05). Areas under the curve of albumin and transferrin were 0.68 (cardiac index, 0.54-0.83) and 0.72 (cardiac index, 0.59-0.86), respectively. At a cutoff value of 87.9 mg/dL, transferrin had a sensitivity of 0.91 in predicting ΔEVLWI 10% or higher. Conclusions: Plasma transferrin and albumin levels were associated with ΔEVLWI 10% or higher after fluid loading. The high sensitivity of both biomarkers indicated that patients with normal values were less likely to develop pulmonary edema after fluid loading. |
| Databáze: | OpenAIRE |
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