动态参数预测老年感染性休克患者液体反应性的准确性

The Accuracy of Dynamic Parameters for Prediction of Fluid Responsiveness in Elderly Patients with Septic Shock.

作者信息

Paphawin Sittikorn, Theerawit Pongdhep, Junhasavasdikul Detajin, Sutherasan Yuda

机构信息

Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Int J Gen Med. 2025 Apr 28;18:2333-2342. doi: 10.2147/IJGM.S517511. eCollection 2025.

DOI:10.2147/IJGM.S517511

PMID:40321933

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12047231/

Abstract

PURPOSE

Assessed the accuracy of stroke volume variation (SVV), pulse pressure variation (PPV), and dynamic arterial elastance (Eadyn) in predicting fluid responsiveness (FR) and mean arterial pressure (MAP) response in elderly patients with septic shock.

PATIENTS AND METHODS

Mechanically ventilated patients aged over 65 with septic shock were enrolled. SVV, PPV, and Eadyn were recorded before and after FR testing (≥10% increase in cardiac output following a passive leg raise test or fluid challenge). MAP responsiveness was defined as a ≥10% increase in MAP post-fluid loading. Receiver operating characteristic curves were constructed to assess predictive parameters such as PPV, SVV for fluid responsiveness, and Eadyn for MAP response after loading. Optimal cutoff values were determined using the Youden index. Sensitivity, specificity, and area under the curve (AUC) were calculated. A p-value <0.05 indicated statistical significance.

RESULTS

The mean age was 76 ± 8 years. Of the 104 patients, 46 were FR-positive. PPV and SVV were higher in FR-positive patients (PPV: 22.07 ± 11.02 vs 9.34 ± 7.39, p < 0.001; SVV: 20 ± 11 vs 9 ± 6, p < 0.001). The AUC was 0.875 for PPV, 95% confidence interval (CI) of 0.802-0.947, and 0.841 for SVV, 95% CI of 0.757 -0.925. Thresholds of 13.5% for PPV and 11.5% for SVV were found, with 81.8% sensitivity and 87% specificity. MAP responders had higher Eadyn (1.31 ± 0.54 vs 1.01 ± 0.93, p = 0.013). Eadyn showed an AUC of 0.844, with a threshold of 1.00 (sensitivity 85.7%, specificity 75%).

CONCLUSION

PV, SVV, and Eadyn are predictors of FR and MAP responsiveness in elderly septic shock patients.

摘要

目的

评估每搏量变异度（SVV）、脉压变异度（PPV）和动态动脉弹性（Eadyn）在预测老年感染性休克患者液体反应性（FR）及平均动脉压（MAP）反应方面的准确性。

患者与方法

纳入年龄超过65岁的感染性休克机械通气患者。在FR测试（被动抬腿试验或液体冲击后心输出量增加≥10%）前后记录SVV、PPV和Eadyn。MAP反应性定义为液体负荷后MAP增加≥10%。构建受试者工作特征曲线以评估预测参数，如用于液体反应性的PPV、SVV以及用于负荷后MAP反应的Eadyn。使用约登指数确定最佳截断值。计算敏感性、特异性和曲线下面积（AUC）。p值<0.05表示具有统计学意义。

结果

平均年龄为76±8岁。104例患者中，46例为FR阳性。FR阳性患者的PPV和SVV更高（PPV：22.07±11.02对9.34±7.39，p<0.001；SVV：20±11对9±6，p<0.001）。PPV的AUC为0.875，95%置信区间（CI）为0.802 - 0.947；SVV的AUC为0.841，95%CI为0.757 - 0.925。发现PPV的阈值为13.5%，SVV的阈值为11.5%，敏感性为81.8%，特异性为87%。MAP反应者的Eadyn更高（1.31±0.54对1.01±0.93，p = 0.013）。Eadyn的AUC为0.844，阈值为1.00（敏感性85.7%，特异性75%）。