Impact of extravascular lung water index on outcomes of severe sepsis patients in a medical intensive care unit.
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.
Chung
Fu-Tsai
FT
Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Lin
Shu-Min
SM
Lin
Shinn-Yn
SY
Lin
Horng-Chyuan
HC
D018806:APACHE; D000368:Aged; D015633:Extravascular Lung Water / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality*; D018805:Sepsis / Q000150:complications / Q000401:mortality*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome