title: Prediction of pulmonary edema by plasma protein levels in patients with sepsis.
abstract: OBJECTIVE
  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
  A total of 62 patients were included, and 27 of them showed a ΔEVLWI 10% or higher after 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 < .05; 107.9 ± 50.1 vs 136.8 ± 44.2 mg/dL for transferrin, P < .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.
authors.affiliation: Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Zhejiang, People's Republic of China. zh_zhang1984@hotmail.com
authors.forename: Zhongheng
authors.initials: Z
authors.lastname: Zhang
authors.forename: Baolong
authors.initials: B
authors.lastname: Lu
authors.forename: Hongying
authors.initials: H
authors.lastname: Ni
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Sheng
authors.forename: Ni
authors.initials: N
authors.lastname: Jin
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D001798:Blood Proteins / Q000032:analysis*; D015633:Extravascular Lung Water; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects / Q000627:therapeutic use*; D011228:Prealbumin / Q000032:analysis; D011654:Pulmonary Edema / Q000097:blood / Q000139:chemically induced*; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000628:therapy*; D013815:Thermodilution; D014168:Transferrin / Q000032:analysis
chemical_list: D015415:Biomarkers; D001798:Blood Proteins; D010952:Plasma Substitutes; D011228:Prealbumin; D014168:Transferrin