Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy.
Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria.
Am J Med Sci. 2024 Jun;367(6):343-351. doi: 10.1016/j.amjms.2024.02.003. Epub 2024 Feb 12.
Infectious states are subtle and rapidly evolving conditions observed daily in the emergency department (ED), and their prognostic evaluation remains a complex clinical challenge. Recently, estimated plasma volume status (ePVS) has been suggested to have a prognostic role in conditions where volemic alteration is central to the pathophysiology. The aim of this study was to verify whether ePVS recorded at ED admission can provide prognostic indications of 30-day mortality in patients with infection.
A prospective observational study was performed between 1 January 2021 and 31 December 2021 at the ED of the Merano Hospital. All patients with infection were enrolled. ePVS values were derived from haemoglobin and haematocrit measured on the immediate arrival of patients in the ED. The predictive power of ePVS for 30-day mortality was assessed using a multivariate model adjusted for severity, comorbidity and urgency. Kaplan-Meier analysis was also performed.
Of the 949 patients with infection enrolled in the study (47.9%, SOFA ≥2), 8.9% (84/949) died at 30 days. The median ePVS value was higher in patients who died at 30 days than in patients who survived (5.83 vs. 4.61, p < 0.001). Multivariate analysis revealed that ePVS in both continuous and categorical form around the median was an independent risk factor for 30-day mortality even after adjusting for severity, comorbidity and urgency. Kaplan-Meier analysis confirmed an increased risk of death in patients with high ePVS values.
ePVS recorded on ED admission of patients with infection was an independent predictor of risk for 30-day mortality.
感染状态是在急诊科（ED）每天都会观察到的微妙且快速演变的情况，其预后评估仍然是一个复杂的临床挑战。最近，估计的血浆容量状态（ePVS）在容量改变是病理生理学核心的情况下被认为具有预后作用。本研究旨在验证 ED 入院时记录的 ePVS 是否可以为感染患者的 30 天死亡率提供预后指标。
一项前瞻性观察研究于 2021 年 1 月 1 日至 2021 年 12 月 31 日在 Merano 医院的 ED 进行。所有感染患者均被纳入研究。ePVS 值由患者在 ED 立即到达时测量的血红蛋白和血细胞比容得出。使用调整严重程度、合并症和紧急程度的多变量模型评估 ePVS 对 30 天死亡率的预测能力。还进行了 Kaplan-Meier 分析。
在纳入研究的 949 例感染患者（47.9%，SOFA≥2）中，8.9%（84/949）在 30 天内死亡。30 天死亡患者的中位 ePVS 值高于存活患者（5.83 与 4.61，p<0.001）。多变量分析显示，即使在调整严重程度、合并症和紧急程度后，连续和分类形式的 ePVS 中位数均为 30 天死亡率的独立危险因素。Kaplan-Meier 分析证实了高 ePVS 值患者死亡风险增加。
感染患者 ED 入院时记录的 ePVS 是 30 天死亡率风险的独立预测因子。
