Capillary Albumin Transudation Rate and Outcome in Critically III Subjects
Study on the relationship between persistently elevated albumin transudation rate and mortality in critically ill subjects. Analyzing capillary leakage using surrogate markers and blood volume analysis to understand outcomes. Results show differences in group characteristics and mortality rates between those with normal and high leak rates.
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Capillary Albumin Transudation Rate and Outcome in Critically Ill Subjects Stephanie Yan, MD, Colin Doyle, MD, David Inouye, MD, Scott Harvey, MD, Michael Hayashi, MD, Richard Severino, PhD, Danny Takanishi, MD, Frank Zhao, MD, Mihae Yu, MD Department of Surgery Division of Surgical Critical Care, University of Hawaii Queen s Medical Center PRESENTED AT:
DISCLOSURES We have nothing to disclose
INTRODUCTION Capillary leakage in inflammatory states multi-organ dysfunction Albumin transudation rate- a surrogate measurement for capillary leakage AIM OF STUDY: relationship between persistently elevated albumin transudation rate and mortality
Blood Volume Analysis A slope of >0.25%= increased capillary permeability
METHODS Retrospective study on subjects with blood volume analysis, 2010 to 2014 Subjects with at least 3 blood volume measurements within 14 days while in the SICU Persistent transudation rate was defined as a value greater than 0.25% more than 33% of the time during the study period Chi-square Multivariate logistic regression : persistently high leak rate on mortality while controlling for APACHE II scores
RESULTS: Group Characteristics Persistent High Leak Rate N=55 Normal Leak Rate N=109 p-value Sex (F:M) Age APACHE II Lactate Hospital LOS Mortality (Survivors:Non-Survivors) Severe sepsis Septic shock Cardiogenic shock Hemorrhagic shock Respiratory failure 17(31%) : 38(69%) 66 17 25 6 3.4 2.8 29 25 32(58%) : 23(42%) 37(67%) 28(51%) 12(22%) 5(9%) 39(71%) 43(39%) : 66(61%) 65 16 23 6 3.0 2.3 39 30 83(76%) : 26(24%) 64(59%) 50(46%) 17(16%) 9(8%) 75(69%) p=0.2837 p=0.7414 p=0.0804 p=0.4203 p=0.0030 p=0.0176 p=0.2875 p=0.5419 p=0.3241 p=0.8568 p=0.7825
RESULTS: by Mortality Survivors (n=115) Non-Survivors (n=49) p-value Persistent High Leak Rate 32 (28%) 23 (47%) p=0.0176 APACHE II 23 6 26 6.0 p=0.0086 Lactate 3.3 2.5 2.8 2.2 p=0.2047 Age 63 17 71 15 p=0.0025 LOS 40 27 25 29 p<0.0001 Severe sepsis 67(58%) 34(69%) p=0.1799 Septic shock 53(46%) 25(51%) p=0.5625 Cardiogenic shock 18(16%) 11(22%) p=0.2964 Hemorrhagic shock 8(7%) 6(12%) p=0.2673 Respiratory failure 81(70%) 33(67%) p=0.6942
RESULTS: Odds Ratio for Mortality Effect Odds Ratio 95% Confidence Limits APACHE II Score 1.08 1.02 1.15 Persistent High Leak 2.15 1.05 4.38 Logistic regression modeling (taking into account APACHE II scores) presence of a persistent high leak is predictive of mortality Odds of dying = 2 times greater when a persistent high leak is present while controlling for APACHE II score Persistently high leak rate has greater effect on mortality than the APACHE II score
CONCLUSIONS Sparse data evaluating albumin transudation rate in clinical settings due to limited technology Persistently elevated albumin transudation rate associated with higher mortality Albumin transudation rate, as a point of care assay, an early clinical tool used to guide treatment and measure response to interventions
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