1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
2 Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts.
Ann Am Thorac Soc. 2016 May;13(5):705-11. doi: 10.1513/AnnalsATS.201511-737OC.
The clinical significance of peripheral edema has not been well described in critical illness.
To assess the clinical significance of peripheral edema detected on physical examination at the time of hospital admission for patients who were treated in an intensive care unit (ICU).
Using a large inception cohort of critically ill patients, we examined the association of peripheral edema, as documented on hospital admission physical examination, with hospital and 1-year survival.
Of 12,778 patients admitted to an ICU at a teaching hospital in Boston, Massachusetts, 2,338 (18%) had peripheral edema. Adjusting for severity of illness and comorbidities, including pulmonary edema, admission peripheral edema was associated with a 26% (95% confidence interval [CI] = 1.11-1.44, P < 0.001) higher risk of hospital mortality. In those patients whose peripheral edema could be graded, trace, 1+, 2+, and 3+ admission peripheral edema was associated with a 2% (95% CI = 0.80-1.31, P = 0.89), 17% (95% CI = 1.00-1.56, P = 0.05), 60% (95% CI = 1.26-2.04, P < 0.001), and 54% (95% CI = 1.04-2.29, P = 0.03) higher adjusted risk of hospital mortality, respectively, compared with patients without edema. The association was consistent across strata of patients with diabetes, congestive heart failure, sepsis, and premorbid diuretic or calcium channel blocker use. In a subset of patients with central venous pressures measurements obtained within 6 hours of ICU admission, the highest central venous pressure quartile (>13 cm H2O) was similarly associated with a 35% (95% CI = 1.05-1.75, P = 0.02) higher adjusted risk of hospital mortality compared with the lowest quartile (≤7 cm H2O).
Peripheral edema, as detected on physical examination at the time of hospital admission, is a poor prognostic indicator in critical illness. Whether peripheral edema simply reflects underlying pathophysiology, or has an independent pathogenic role, will require further interventional studies.
外周水肿在危重病中的临床意义尚未得到很好的描述。
评估重症监护病房（ICU）入院时体格检查发现的外周水肿与医院和 1 年生存率的关系。
使用大量危重病患者的队列研究，我们检查了入院时体格检查记录的外周水肿与医院和 1 年生存率的关系。
在马萨诸塞州波士顿一所教学医院的 ICU 中，12778 名患者中，有 2338 名（18%）有外周水肿。调整严重程度和合并症（包括肺水肿）后，入院时的外周水肿与住院死亡率增加 26%（95%置信区间[CI]1.11-1.44，P<0.001）相关。在那些可以分级的患者中，微量、1+、2+和 3+入院时的外周水肿与住院死亡率增加 2%（95%CI 0.80-1.31，P=0.89）、17%（95%CI 1.00-1.56，P=0.05）、60%（95%CI 1.26-2.04，P<0.001）和 54%（95%CI 1.04-2.29，P=0.03）相关。该关联在糖尿病、充血性心力衰竭、脓毒症和预先使用利尿剂或钙通道阻滞剂的患者亚组中是一致的。在 ICU 入院后 6 小时内获得中心静脉压测量值的患者亚组中，最高中心静脉压四分位数（>13cmH2O）与住院死亡率增加 35%（95%CI 1.05-1.75，P=0.02）相关，而最低四分位数（≤7cmH2O）。
入院时体格检查发现的外周水肿是危重病预后不良的指标。外周水肿是否仅反映潜在的病理生理学，还是具有独立的发病作用，需要进一步的干预研究。
