Abstract
BackgroundThis study was designated to investigate whether increased extravascular lung water index (EVLWI) may correlate multiple organ dysfunction syndrome (MODS) and mortality in sepsis.MethodsWe designed a prospective cohort study in an intensive care unit of a tertiary care hospital. Sixty-seven patients with severe sepsis were included. Data were used to determine an association between EVLWI and the development of MODS and mortality. These connections were determined by the multiple logistic regression, plotting the receiver operating characteristic (ROC) curve and by Spearman test.ResultsEVLWI levels were higher in MODS patients on day 1 (median (IQR), 18(12.8–23.9) ml/kg, n = 38, p<0.0001) than in those without (median (IQR), 12.4 (7.9–16.3) ml/kg, n = 29) and day 3 (median (IQR), 17.8 (11.2–22.8) ml/kg, n = 29, p = 0.004) than in those without (median (IQR), 12.4 (8.0–16.3) ml/kg, n = 29). EVLWI was used as an independent predictor of the development of MODS (odds ratio, 1.6; p = 0.005; 95% confidence interval, 1.2∼2.2) during ICU stay. The area under the ROC curve showed that EVLWI levels could predict MODS (0.866) and mortality (0.881) during ICU stay. Meanwhile, the higher of SOFA score, the more EVLWI was found on day 1 (r = 0.7041, p<0.0001) and day 3 (r = 0.7732, p<0.0001).ConclusionsIncreased EVLWI levels correlates development of MODS and mortality during the patients' ICU stay. Further more, the potential of novel treatment in severe sepsis with lung injury may develop.
Highlights
The incidence of sepsis has been increasing because of the advancing age of the general population, a greater number of invasive procedures, and more immunosuppressive therapies [1]
extravascular lung water index (EVLWI) remained higher in patients with multiple organ dysfunction syndrome (MODS) on day1 and 3
The higher of Sequential Organ Failure Assessment (SOFA) score, the more EVLWI was found on day 1 (r = 0.7041, p,0.0001) and day 3 (r = 0.7732, p,0.0001)
Summary
The incidence of sepsis has been increasing because of the advancing age of the general population, a greater number of invasive procedures, and more immunosuppressive therapies [1]. Severe sepsis is frequently complicated by multiple organ dysfunction syndrome (MODS). MODS means two or more organs are dysfunctional; when three or more organs are involved, MODS cause 60% to 98% death of severe sepsis [2,3]. The severity of organ dysfunction is an important determinant of prognosis in sepsis [8,9]. Despite MODS is important in the patients with severe sepsis, the pathogenesis including endothelial injury and permeability change in sepsis and MODS is not clear. This study was designated to investigate whether increased extravascular lung water index (EVLWI) may correlate multiple organ dysfunction syndrome (MODS) and mortality in sepsis
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