Abbasi Saeed, Nemati Kourosh, Alikiaii Babak, Saghaei Mahmood
Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2023 Feb 25;12:38. doi: 10.4103/abr.abr_394_21. eCollection 2023.
The hypo-perfusion of the kidneys can lead to impairment in renal function and induce renal injury in case of delayed diagnosis and treatment. To date, laboratory markers are routinely used to determine the fluid volume status of the patients. The current study aims to evaluate the values of inferior vena cava (IVC) collapsibility index in hypovolemia diagnosis among critical patients admitted at the intensive care unit (ICU).
This is a cross-sectional study performed on 67 patients admitted to the ICU due to acute kidney injury from May 2018 to October 2019. Hypovolemia was assessed assessing IVC collapsibility using ultrasonography. Laboratory data, including urine osmolality, urine-plasma creatinine ratio, sodium excretion fraction and urinary sodium level were checked. Afterward, IVC collapsibility index was measured for each patient using ultrasonography and the values of this index in accordance with the mentioned criteria was evaluated. Accordingly, reciever operating curve was depicted.
There was no significant asosociation between IVC collapsibility index with fractional excretion of sodium ( = 0.69), urine Na ( = 0.93) and urine osmolality ([ = 0.09]), while urine: Plasma creatinie ration revealed a significant association with IVC collapsibility index at cut point of 40.5% with sensitivity and specificity of 96% and 44% ( = 0.017, area under the curve: 0.67, 95% confidence interval: 0.551-0.804), respectively.
According to the findings of this study, IVC collapsibility detected via ultrasonography was not an appropriate index to figure out hypovolemia in ICU patients. Furthermore, detailed studies are recommended.
肾脏灌注不足可导致肾功能损害，若诊断和治疗延迟则会引发肾损伤。迄今为止，实验室指标常被用于确定患者的血容量状态。本研究旨在评估下腔静脉（IVC）可塌陷指数在重症监护病房（ICU）收治的危重症患者低血容量诊断中的价值。
这是一项横断面研究，对2018年5月至2019年10月因急性肾损伤入住ICU的67例患者进行。通过超声检查评估IVC可塌陷性来评估低血容量。检查实验室数据，包括尿渗透压、尿肌酐与血肌酐比值、钠排泄分数和尿钠水平。随后，使用超声检查测量每位患者的IVC可塌陷指数，并根据上述标准评估该指数的值。据此绘制受试者工作曲线。
IVC可塌陷指数与钠排泄分数（=0.69）、尿钠（=0.93）和尿渗透压（[=0.09]）之间无显著相关性，而尿肌酐与血肌酐比值在切点为40.5%时与IVC可塌陷指数显示出显著相关性，敏感性和特异性分别为96%和44%（=0.017，曲线下面积：0.67，95%置信区间：0.551 - 0.804）。
根据本研究结果，通过超声检测的IVC可塌陷性并非判断ICU患者低血容量的合适指标。此外，建议进行详细研究。
