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Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock

Chew, Michelle LU ; Ihrman, Lilian; Düring, Joachim LU ; Bergenzaun, Lill LU ; Ersson, Anders LU ; Undén, Johan LU ; Ryden, Jorgen; Akerman, Eva and Larsson, Marina (2012) In Critical Care 16(1).
Abstract
Introduction: The diagnosis of acute lung injury (ALI) may be more robust if more accurate physiological markers can be identified. Extravascular lung water (EVLW) is one possible marker, and it has been shown to correlate with respiratory function and mortality in patients with sepsis. Whether EVLW confers diagnostic value in a general population with shock, as well as which index performs best, is unclear. We investigated the diagnostic accuracy of various EVLW indices in patients with shock. Methods: We studied a prospective, observational cohort of 51 patients with shock admitted to a tertiary ICU. EVLW was measured within 6 hours of ICU admission and indexed to actual body weight (EVLW/ABW), predicted body weight (EVLW/PBW) and... (More)
Introduction: The diagnosis of acute lung injury (ALI) may be more robust if more accurate physiological markers can be identified. Extravascular lung water (EVLW) is one possible marker, and it has been shown to correlate with respiratory function and mortality in patients with sepsis. Whether EVLW confers diagnostic value in a general population with shock, as well as which index performs best, is unclear. We investigated the diagnostic accuracy of various EVLW indices in patients with shock. Methods: We studied a prospective, observational cohort of 51 patients with shock admitted to a tertiary ICU. EVLW was measured within 6 hours of ICU admission and indexed to actual body weight (EVLW/ABW), predicted body weight (EVLW/PBW) and pulmonary blood volume (EVLW/PBV). The relationship of these indices to the diagnosis and severity of lung injury and ICU mortality were studied. Positive and negative likelihood ratios, pre- and posttest odds for diagnosis of lung injury and mortality were calculated. Results: All EVLW indices were higher among patients with lung injury and significantly correlated with respiratory parameters. Furthermore, all EVLW indices were significantly higher in nonsurvivors. The use of EVLW improves the posttest OR for the diagnosis of ALI, acute respiratory distress syndrome (ARDS) and severe lung injury (sLI) by up to eightfold. Combining increased EVLW and a diagnosis of ALI, ARDS or sLI increases the posttest odds of ICU mortality. EVLW/ABW and EVLW/PBV demonstrated the best diagnostic performance in this population. Conclusions: EVLW was associated with degree of lung injury and mortality, regardless of the index used, confirming that it may be used as a bedside indicator of disease severity. The use of EVLW as a bedside test conferred added diagnostic value for the identification of patients with lung injury. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute respiratory distress syndrome, acute lung injury, extravascular, lung water, sepsis, shock, pulmonary oedema, likelihood ratio
in
Critical Care
volume
16
issue
1
publisher
BioMed Central
external identifiers
  • wos:000305393400001
  • scopus:84855250822
ISSN
1364-8535
DOI
10.1186/cc10599
language
English
LU publication?
yes
id
dc35f6eb-2fe8-4e13-a6ad-684fbfae520e (old id 2890928)
date added to LUP
2012-08-01 08:54:40
date last changed
2017-10-29 03:04:21
@article{dc35f6eb-2fe8-4e13-a6ad-684fbfae520e,
  abstract     = {Introduction: The diagnosis of acute lung injury (ALI) may be more robust if more accurate physiological markers can be identified. Extravascular lung water (EVLW) is one possible marker, and it has been shown to correlate with respiratory function and mortality in patients with sepsis. Whether EVLW confers diagnostic value in a general population with shock, as well as which index performs best, is unclear. We investigated the diagnostic accuracy of various EVLW indices in patients with shock. Methods: We studied a prospective, observational cohort of 51 patients with shock admitted to a tertiary ICU. EVLW was measured within 6 hours of ICU admission and indexed to actual body weight (EVLW/ABW), predicted body weight (EVLW/PBW) and pulmonary blood volume (EVLW/PBV). The relationship of these indices to the diagnosis and severity of lung injury and ICU mortality were studied. Positive and negative likelihood ratios, pre- and posttest odds for diagnosis of lung injury and mortality were calculated. Results: All EVLW indices were higher among patients with lung injury and significantly correlated with respiratory parameters. Furthermore, all EVLW indices were significantly higher in nonsurvivors. The use of EVLW improves the posttest OR for the diagnosis of ALI, acute respiratory distress syndrome (ARDS) and severe lung injury (sLI) by up to eightfold. Combining increased EVLW and a diagnosis of ALI, ARDS or sLI increases the posttest odds of ICU mortality. EVLW/ABW and EVLW/PBV demonstrated the best diagnostic performance in this population. Conclusions: EVLW was associated with degree of lung injury and mortality, regardless of the index used, confirming that it may be used as a bedside indicator of disease severity. The use of EVLW as a bedside test conferred added diagnostic value for the identification of patients with lung injury.},
  author       = {Chew, Michelle and Ihrman, Lilian and Düring, Joachim and Bergenzaun, Lill and Ersson, Anders and Undén, Johan and Ryden, Jorgen and Akerman, Eva and Larsson, Marina},
  issn         = {1364-8535},
  keyword      = {acute respiratory distress syndrome,acute lung injury,extravascular,lung water,sepsis,shock,pulmonary oedema,likelihood ratio},
  language     = {eng},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {Critical Care},
  title        = {Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock},
  url          = {http://dx.doi.org/10.1186/cc10599},
  volume       = {16},
  year         = {2012},
}