title: Admission Peripheral Edema, Central Venous Pressure, and Survival in Critically Ill Patients.
abstract: The clinical significance of peripheral edema has not been well described in critical illness.
  
  
  
  To assess the clinical significance of peripheral edema detected on physical examination at the time of hospital admission for patients who were treated in an intensive care unit (ICU).
  
  
  
  Using a large inception cohort of critically ill patients, we examined the association of peripheral edema, as documented on hospital admission physical examination, with hospital and 1-year survival.
  
  
  
  Of 12,778 patients admitted to an ICU at a teaching hospital in Boston, Massachusetts, 2,338 (18%) had peripheral edema. Adjusting for severity of illness and comorbidities, including pulmonary edema, admission peripheral edema was associated with a 26% (95% confidence interval [CI] = 1.11-1.44, P < 0.001) higher risk of hospital mortality. In those patients whose peripheral edema could be graded, trace, 1+, 2+, and 3+ admission peripheral edema was associated with a 2% (95% CI = 0.80-1.31, P = 0.89), 17% (95% CI = 1.00-1.56, P = 0.05), 60% (95% CI = 1.26-2.04, P < 0.001), and 54% (95% CI = 1.04-2.29, P = 0.03) higher adjusted risk of hospital mortality, respectively, compared with patients without edema. The association was consistent across strata of patients with diabetes, congestive heart failure, sepsis, and premorbid diuretic or calcium channel blocker use. In a subset of patients with central venous pressures measurements obtained within 6 hours of ICU admission, the highest central venous pressure quartile (>13 cm H2O) was similarly associated with a 35% (95% CI = 1.05-1.75, P = 0.02) higher adjusted risk of hospital mortality compared with the lowest quartile (≤7 cm H2O).
  
  
  
  Peripheral edema, as detected on physical examination at the time of hospital admission, is a poor prognostic indicator in critical illness. Whether peripheral edema simply reflects underlying pathophysiology, or has an independent pathogenic role, will require further interventional studies.
authors.affiliation: 1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Danziger
authors.affiliation: 1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Ken
authors.initials: K
authors.lastname: Chen
authors.affiliation: 2 Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: Cavender
authors.affiliation: 2 Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts.|3 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; and.
authors.forename: Joon
authors.initials: J
authors.lastname: Lee
authors.affiliation: 2 Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts.|4 Institute for Infocomm Research, Agency for Science, Technology, and Research, Singapore.
authors.forename: Mengling
authors.initials: M
authors.lastname: Feng
authors.affiliation: 2 Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Mark
authors.affiliation: 1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: 1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|2 Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002496:Central Venous Pressure; D016638:Critical Illness / Q000401:mortality*; D004487:Edema / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D011654:Pulmonary Edema / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012720:Severity of Illness Index
keywords: central venous pressure; mortality; peripheral edema; pulmonary edema; venous congestion