Impact of extravascular lung water index on outcomes of severe sepsis patients in a medical intensive care unit

SummaryBackgroundThis study was designated to investigate whether extravascular lung water index (EVLI) is an independent predictor for mortality outcome in patients with severe sepsis.MethodsThis 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 48 h of the patient meeting the criteria for severe sepsis.ResultsIn 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 24 h 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 10 ml/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 (⩾10 ml/kg) had lower in-hospital survival rate than those with a low EVLI (<10 ml/kg) (15% vs. 67.7%, respectively, p<0.001.ConclusionsThis 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.