Central venous pressure measurement is associated with improved outcomes in septic patients: an analysis of the MIMIC-III database

Hui Chen,Yao Wei,Jun Jin,Dongyu Chen,Yanxia Guo,Zhu Zhu,Chenyan Zhao

doi:10.1186/s13054-020-03109-9

Abstract

PurposeMeasurement of central venous pressure (CVP) can be a useful clinical tool. However, the formal utility of CVP measurement in preventing mortality in septic patients has never been proven.MethodsThe Medical Information Mart for Intensive Care III (MIMIC-III) database was searched to identify septic patients with and without CVP measurements. The primary outcome was 28-day mortality. Multivariate regression was used to elucidate the relationship between CVP measurement and 28-day mortality, and propensity score matching (PSM) and an inverse probability of treatment weighing (IPTW) were employed to validate our findings.ResultsA total of 10,275 patients were included in our study, of which 4516 patients (44%) underwent CVP measurement within 24 h of intensive care unit (ICU) admission. The risk of 28-day mortality was reduced in the CVP group (OR 0.60 (95% CI 0.51–0.70; p < 0.001)). Patients in the CVP group received more fluid on day 1 and had a shorter duration of mechanical ventilation and vasopressor use, and the reduction in serum lactate was greater than that in the no CVP group. The mediating effect of serum lactate reduction was significant for the whole cohort (p = 0.04 for the average causal mediation effect (ACME)) and patients in the CVP group with an initial CVP level below 8 mmHg (p = 0.04 for the ACME).ConclusionCVP measurement was associated with decreased risk-adjusted 28-day mortality among patients with sepsis and was proportionally mediated through serum lactate reduction.

Highlights

Sepsis is a major challenge in intensive care unit (ICU) settings and accounts for approximately 30 to 50% of shortterm mortality [1, 2]
A retrospective study conducted by Legrand declared that a high central venous pressure (CVP) value within the first 24 h of admission was associated with the risk of developing new or persistent acute kidney injury (AKI) [6], and limiting CVP in liver surgery is associated with a decreased risk of bleeding and improved perioperative outcomes [7]
Our study demonstrated that CVP measurement was associated with significantly lower risk-adjusted 28day mortality than no CVP measurement for the first time, as well as lower in-hospital and 1-year mortality, while no association with AKI within 7-days was detected

Summary

Introduction

Sepsis is a major challenge in intensive care unit (ICU) settings and accounts for approximately 30 to 50% of shortterm mortality [1, 2]. Fluid administration is a double-edged sword; the benefits of fluid administration include an increase in cardiac output, but the risks include an increase in hydrostatic pressure, increasing oedema formation. It is more beneficial and less risky to administer fluids in patients with a lower CVP than in those with a high CVP. Another study demonstrated that a goal-directed protocol using CVP, mean arterial pressure (MAP) and urine output values as therapeutic goals improved survival and clinical outcomes in patients with septic shock [10]. The formal utility of CVP measurement in predicting mortality in septic patients has never been proven

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