Association between elevated central venous pressure and outcomes in critically ill patients

Dong-Kai Li,Xiao-Ting Wang,Da-Wei Liu

doi:10.1186/s13613-017-0306-1

Abstract

BackgroundSome prior studies have shown that elevated mean central venous pressure in certain patient populations and disease processes may lead to poor prognosis. However, these studies failed to generalize the concept of elevated central venous pressure (ECVP) load to all patients in critical care settings because of the limited cases and exclusive cohorts. The aim of the study was to investigate the association between elevated central venous pressure and outcomes in critical care.MethodsWe performed a retrospective analysis on a single-center public database (MIMIC) of more than 9000 patients and more than 500,000 records of central venous pressure measurement. We evaluated the association between mean central venous pressure level and 28-day mortality after intensive care unit admission. The secondary outcomes were duration of mechanical ventilation, vasoactive drug use, laboratory results related to organ dysfunction and length of intensive care unit hospitalization. Accordingly, we proposed the concept of ECVP10 (the time sum of CVP above 10 mmHg) and investigated its association with outcome.ResultsThere were 1645 deaths at 28 days after admission. Compared with the lowest quartile of mean central venous pressure [mean (SD) 7.4 (1.9) mmHg], the highest quartile [17.4 (4.1) mmHg] was associated with a 33.6% (95% CI 1.117–1.599) higher adjusted risk of death. Poor secondary outcomes were also associated with higher quartiles of elevated mean central venous pressure. After stratification by mean central venous pressure, elevated duration of central venous pressure above 10 mmHg was significantly higher in the non-survival group than in the survival group.ConclusionsElevated central venous pressure level correlated with poor outcomes and prolonged treatment in critical care settings. Level and duration of elevated central venous pressure should be both evaluated to establish its cause and apply appropriate treatment.

Highlights

Some prior studies have shown that elevated mean central venous pressure in certain patient popula‐ tions and disease processes may lead to poor prognosis
Public, de-identified clinical database, Multi-parameter Intelligent Monitoring in Intensive Care (MIMIC-III) [13], we evaluated the effect of elevated central venous pressure (ECVP) on all patients in critical care settings, for whom central venous pressure (CVP) data were carefully recorded
This study investigated the association between ECVP load and outcomes of patients in critical care setting

Summary

Introduction

Some prior studies have shown that elevated mean central venous pressure in certain patient popula‐ tions and disease processes may lead to poor prognosis. These studies failed to generalize the concept of elevated central venous pressure (ECVP) load to all patients in critical care settings because of the limited cases and exclusive cohorts. For patients with cardiovascular diseases, ECVP might be associated with impaired hepatic and renal function and may be independently related to all-cause mortality [8, 9] These studies, could not generalize the concept of elevated central venous pressure (ECVP) load to all patients in critical care settings because of the limited cases and exclusive cohorts. The importance of ECVP duration was underestimated in estimating the ECVP load and analyzing its relationship with outcome, which is only accessible with the advantage of “big data” technology [12]

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