J Korean Med Sci.  2022 May;37(18):e145. 10.3346/jkms.2022.37.e145.

Prognostic Value of Estimated Plasma Volume Status in Patients With Sepsis

• Kim KH
• Cho HJ
• Kim SC
• Lee J

• KMID: 2529711
• DOI: http://doi.org/10.3346/jkms.2022.37.e145

Abstract

Background
In patients with sepsis, timely risk stratification is important to improve prognosis. Although several clinical scoring systems are currently being used to predict the outcome of sepsis, but they all have certain limitations. The objective of this study was to evaluate the prognostic value of estimated plasma volume status (ePVS) in patients admitted to the intensive care unit (ICU) with sepsis or septic shock.
Methods
This single-center, prospective observational study, included 100 patients admitted to the ICU with sepsis or septic shock. Informed consent, blood samples, and co-morbidity data were obtained from the patients on admission, and the severity of sepsis was recorded. The primary outcome was in-hospital mortality and multivariable logistic regression analysis was used to adjust for confounding factors to determine the significant prognostic factor.
Results
The in-hospital mortality was 47%. The ePVS was correlated with the amount of total fluids administered 24 hours before the ICU admission. The mean ePVS in patients who died was higher than in those who survived (7.7 ± 2.1 dL/g vs. 6.6 ± 1.6 dL/g, P = 0.003). To evaluate the utility of ePVS in predicting in-hospital mortality, a receiver operating characteristic curve was produced. Sensitivity and specificity were optimal at a cut-off point of 7.09 dL/g, with an area under the curve of 0.655. In the multivariate analysis, higher ePVS was significantly associated with higher in-hospital mortality adjusted odds ratio, 1.39; 95% confidence interval, 1.04–1.85, P = 0.028). The Kaplan-Meier curve showed that an ePVS value above 7.09 was associated with an increased risk of in-hospital mortality compared with the rest of the population (P = 0.004).
Conclusion
The ePVS was correlated with the amount of intravenous fluid resuscitation and may be used as a simple and novel prognostic factor in patients with sepsis or septic shock who are admitted to the ICU.

Keyword

Sepsis; Estimated Plasma Volume Status; Prognostic Value

Figure

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  Fig. 1 Study flow diagram.ICU = intensive care unit, ePVS = estimated plasma volume status.

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  Fig. 2 Comparison of receiver operating characteristics curves of ePVS, SAPS3, and SOFA for predicting in-hospital mortality in critically ill patients with sepsis.ePVS = estimated plasma volume status, SAPS3 = Simplified Acute Physiology Score 3, SOFA = sequential organ failure assessment.

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  Fig. 3 Kaplan-Meier survival analysis plot for in-hospital mortality divided between above and below cut-off ePVS value (7.09 dL/g).ePVS = estimated plasma volume status.

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