Bernhard Wernly1, Sebastian Haumann2, Maryna Masyuk3,4, Johanna Muessig3,4, Michael Lichtenauer1, Laura Bäz5, Marcus Franz5, Alexander Pfeil6, Alexander Lauten7,8, Paul Christian Schulze5, Uta C Hoppe1, Malte Kelm3,4, Ralf Westenfeld3,4, Christian Jung9,10, Diane Renz2. 1. Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria. 2. Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany. 3. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany. 4. Cardiovascular Research Institute Duesseldorf (CARID), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Duesseldorf, Germany. 5. Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany. 6. Clinic of Internal Medicine III, Jena University Hospital, Jena, Germany. 7. Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany. 8. Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany. 9. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany. christian.jung@med.uni-duesseldorf.de. 10. Cardiovascular Research Institute Duesseldorf (CARID), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Duesseldorf, Germany. christian.jung@med.uni-duesseldorf.de.
Abstract
OBJECTIVE: The aim of this study was to describe real world extravascular lung water index (EVLWI) measurements obtained by pulse index continuous cardiac output (PiCCO) on the day of admission. These were then related to a radiologic score for lung edema, Halperin score and both the Halperin score and EVLWI were assessed for prediction of in-hospital mortality in critically ill patients. METHODS AND RESULTS: A total of 311 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis and of these 177 patients were intubated. In-hospital mortality was assessed by logistic regression. In the overall cohort, EVLWI and the Halperin score correlated poorly (r = 0.17; p = 0.02). In intubated patients, EVLWI and Halperin score did not correlate (r = 0.09; p = 0.39), whereas in patients who were not intubated there was a moderate association (r = 0.30; p = 0.007). In the overall cohort, (a) EVLWI (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.02-1.19; p = 0.01; area under the curve [AUC] 0.63, 95% CI 0.54-0.71) but not (b) Halperin score (HR 1.00, 95% CI 0.996-1.004; p = 0.94; AUC 0.52, 95% CI 0.45-0.58) was associated with in-hospital mortality There was a robust association of EVLWI (HR 1.12, 95% CI 1.01-1.25; p = 0.03) but not Halperin score (HR 1.003, 95% CI 0.997-1.009; p = 0.30) with mortality in non-intubated patients. In intubated patients, neither EVLWI (HR 0.997 95% CI 0.990-1.003; p = 0.33) nor Halperin score (HR 1.08; 95% CI 0.88-1.32; p = 0.47) was associated with mortality. CONCLUSION: The EVLWI correlated moderately with a radiologic score for lung edema, the Halperin score, in non-intubated but not in intubated patients. The EVLWI at admission was associated with in-hospital mortality in our patient collective of critically ill patients and might constitute not only a tool for risk stratification but most importantly a valuable treatment goal.
OBJECTIVE: The aim of this study was to describe real world extravascular lung water index (EVLWI) measurements obtained by pulse index continuous cardiac output (PiCCO) on the day of admission. These were then related to a radiologic score for lung edema, Halperin score and both the Halperin score and EVLWI were assessed for prediction of in-hospital mortality in critically illpatients. METHODS AND RESULTS: A total of 311 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis and of these 177 patients were intubated. In-hospital mortality was assessed by logistic regression. In the overall cohort, EVLWI and the Halperin score correlated poorly (r = 0.17; p = 0.02). In intubated patients, EVLWI and Halperin score did not correlate (r = 0.09; p = 0.39), whereas in patients who were not intubated there was a moderate association (r = 0.30; p = 0.007). In the overall cohort, (a) EVLWI (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.02-1.19; p = 0.01; area under the curve [AUC] 0.63, 95% CI 0.54-0.71) but not (b) Halperin score (HR 1.00, 95% CI 0.996-1.004; p = 0.94; AUC 0.52, 95% CI 0.45-0.58) was associated with in-hospital mortality There was a robust association of EVLWI (HR 1.12, 95% CI 1.01-1.25; p = 0.03) but not Halperin score (HR 1.003, 95% CI 0.997-1.009; p = 0.30) with mortality in non-intubated patients. In intubated patients, neither EVLWI (HR 0.997 95% CI 0.990-1.003; p = 0.33) nor Halperin score (HR 1.08; 95% CI 0.88-1.32; p = 0.47) was associated with mortality. CONCLUSION: The EVLWI correlated moderately with a radiologic score for lung edema, the Halperin score, in non-intubated but not in intubated patients. The EVLWI at admission was associated with in-hospital mortality in our patient collective of critically illpatients and might constitute not only a tool for risk stratification but most importantly a valuable treatment goal.
Authors: Vsevolod V Kuzkov; Mikhail Y Kirov; Mikhail A Sovershaev; Vladimir N Kuklin; Evgeny V Suborov; Kristine Waerhaug; Lars J Bjertnaes Journal: Crit Care Med Date: 2006-06 Impact factor: 7.598
Authors: Bernhard Wernly; Michael Lichtenauer; Marcus Franz; Michael Fritzenwanger; Bjoern Kabisch; Hans-Reiner Figulla; Christian Jung Journal: Wien Klin Wochenschr Date: 2016-08-15 Impact factor: 1.704