Department of Critical Care, Georgetown University Medstar Washington Hospital Center, Washington, DC, USA.
Department of Emergency Medicine, Georgetown University Medstar Washington Hospital Center, Washington, DC, USA.
Crit Care. 2020 Oct 19;24(1):615. doi: 10.1186/s13054-020-03330-6.
Changes in Doppler flow patterns of hepatic veins (HV), portal vein (PV) and intra-renal veins (RV) reflect right atrial pressure and venous congestion; the feasibility of obtaining these assessments and the clinical relevance of the findings is unknown in a general ICU population. This study compares the morphology of HV, PV and RV waveform abnormalities in prediction of major adverse kidney events at 30 days (MAKE30) in critically ill patients.
We conducted a prospective observational study enrolling adult patients within 24 h of admission to the ICU. Patients underwent an ultrasound evaluation of the HV, PV and RV. We compared the rate of MAKE-30 events in patients with and without venous flow abnormalities in the hepatic, portal and intra-renal veins. The HV was considered abnormal if S to D wave reversal was present. The PV was considered abnormal if the portal pulsatility index (PPI) was greater than 30%. We also examined PPI as a continuous variable to assess whether small changes in portal vein flow was a clinically important marker of venous congestion.
From January 2019 to June 2019, we enrolled 114 patients. HV abnormalities demonstrate an odds ratio of 4.0 (95% CI 1.4-11.2). PV as a dichotomous outcome is associated with an increased odds ratio of MAKE-30 but fails to reach statistical significance (OR 2.3 95% CI 0.87-5.96), but when examined as a continuous variable it demonstrates an odds ratio of 1.03 (95% CI 1.00-1.06). RV Doppler flow abnormalities are not associated with an increase in the rate of MAKE-30 INTERPRETATION: Obtaining hepatic, portal and renal venous Doppler assessments in critically ill ICU patients are feasible. Abnormalities in hepatic and portal venous Doppler are associated with an increase in MAKE-30. Further research is needed to determine if venous Doppler assessments can be useful measures in assessing right-sided venous congestion in critically ill patients.
肝静脉（HV）、门静脉（PV）和肾内静脉（RV）的多普勒血流模式变化反映右心房压力和静脉充血；在普通 ICU 人群中，获得这些评估结果的可行性及其临床相关性尚不清楚。本研究比较了危重患者 HV、PV 和 RV 波形态异常对 30 天主要不良肾脏事件（MAKE30）的预测价值。
我们进行了一项前瞻性观察性研究，纳入了 ICU 入院后 24 小时内的成年患者。患者接受了 HV、PV 和 RV 的超声评估。我们比较了肝、门和肾静脉存在静脉血流异常的患者和无静脉血流异常的患者发生 MAKE-30 事件的发生率。HV 异常定义为 S 波至 D 波反转。PV 异常定义为门静脉搏动指数（PPI）大于 30%。我们还将 PPI 作为连续变量进行检查，以评估门静脉血流的微小变化是否是静脉充血的重要临床标志物。
2019 年 1 月至 6 月，我们纳入了 114 名患者。HV 异常的优势比为 4.0（95%CI 1.4-11.2）。PV 作为二分类结果与 MAKE-30 增加的比值比相关，但未达到统计学意义（OR 2.3 95%CI 0.87-5.96），但当作为连续变量检查时，其比值比为 1.03（95%CI 1.00-1.06）。RV 多普勒血流异常与 MAKE-30 发生率增加无关。
在危重症 ICU 患者中获得肝、门和肾静脉多普勒评估是可行的。肝静脉和门静脉多普勒异常与 MAKE-30 增加相关。需要进一步研究确定静脉多普勒评估是否可用于评估危重症患者的右侧静脉充血。
