Liu Xiaodong, Wang Fei, Xu Wangbin, Yang Man, Yang Xiao, Dai Dongmei, Xiao-Li Leyun, Guan Xinghui, Su Xiaoyang, Cui Yuemeng, Cai Lei
Department of Intensive Care Unit, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China. Corresponding author: Xu Wangbin, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jul;37(7):620-627. doi: 10.3760/cma.j.cn121430-20240729-00641.
To investigate the feasibility and prognostic implications of assessing volume status during early fluid resuscitation in septic patients based on estimated plasma volume status (ePVS).
A prospective study was conducted. Patients with sepsis admitted to intensive care unit (ICU) of the First Affiliated Hospital of Kunming Medical University from March to December in 2023 were enrolled. The general information and laboratory indicators at ICU admission were recorded, and ePVS, sequential organ failure assessment (SOFA) score, acute physiology and chronic health status evaluation II (APACHE II) score were calculated. The vital signs, arterial blood gas analysis and volume status related indicators before liquid resuscitation (T0h) and 3 hours (T3h) and 6 hours (T6h) of fluid resuscitation were recorded. The diameter and variability of the inferior vena cava (IVC) were measured by ultrasound, and ePVS, percentage change value of estimated plasma volume status (ΔePVS%), difference in central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO), and lactate clearance rate (LCR) were calculated. Patients were divided into sepsis group and septic shock group based on the diagnosis at ICU admission, and septic patients were subdivided into survival group and death group based on their 28-day survival status. The differences in clinical data between the groups were compared. The correlation between ePVS or ΔePVS% and volume status related indicators during early liquid resuscitation was analyzed by Spearman rank sum correlation test. The predictive value of each variable for 28-day survival in patients with sepsis was analyzed by receiver operator characteristic curve (ROC curve), and 28-day death risk factors were analyzed by Logistic regression method.
Fifty-four septic patients were enrolled in the final analysis, including 17 with sepsis and 37 with septic shock; 34 survived at 28 days and 20 died, with a 28-day survival rate of 63.0%. Compared with the sepsis group, the septic shock group had a lower venous ePVS at ICU admission [dL/g: 4.96 (3.67, 7.15) vs. 7.55 (4.36, 10.07), P < 0.05]. Compared with the death group, the survival group had higher T6h arterial and venous ΔePVS%, and albumin [Alb; T6h arterial ΔePVS% (%): 11.57% (-1.82%, 31.35%) vs. 0.48% (-5.67%, 6.02%), T6h venous ΔePVS%: 9.62% (3.59%, 25.75%) vs. 1.52% (-9.65%, 7.72%), Alb (g/L): 27.57±4.15 vs. 23.77±6.97, all P < 0.05], lower SOFA score, APACHE II score, AST, T0h Lac, and T3h and T6h norepinephrine dosage [SOFA score: 9.00 (8.00, 10.00) vs. 11.50 (9.25, 14.50), APACHE II score: 18.00 (14.75, 21.25) vs. 25.50 (21.00, 30.00), AST (U/L): 34.09 (23.20, 56.64) vs. 79.24 (25.34, 196.59), T0h Lac (mmol/L): 1.75 (1.40, 2.93) vs. 3.25 (2.33, 5.30), norepinephrine dosage (mg): 0.98 (< 0.01, 3.10) vs. 4.60 (1.05, 8.55) at T3h, 1.82 (0.38, 5.30) vs. 8.20 (2.80, 17.73) at T6h, all P < 0.05]. While there were no significantly differences in other basic data and ePVS at all of the time points before and after resuscitation between the two groups. Correlation analysis showed that T6h venous ePVS was significantly positively correlated with T6h IVC variability in septic patients (r = 0.360, P < 0.05), T0h arterial ePVS was significantly negatively correlated with T3h and T6h liquid intake volume (r = -0.367, r = -0.280, both P < 0.05), and venous ePVS at ICU admission was significantly positively correlated with NT-proBNP at ICU admission (r = 0.409, P < 0.05). T6h venous ΔePVS% was significantly positively correlated with T3h liquid intake volume and T6h LCR (r = 0.286, r = 0.286, both P < 0.05), and significantly negatively correlated with T6h urine volume and T6h change value of Pcv-aCO (ΔPcv-aCO; r = -0.321, r = -0.371, both P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of T6h venous ΔePVS% for predicting 28-day survival in septic patients was 0.726 [95% confidence interval (95%CI) was 0.578-0.875, P = 0.006], with a sensitivity of 82.4%, a specificity of 60.0%, and an optimal cut-off value of 3.09%. Binary multifactorial Logistic regression analysis showed that an increase in T6h venous ΔePVS% was a protective factor for 28-day death in patients with sepsis on early fluid resuscitation [odds ratio (OR) = 0.900, 95%CI was 0.834-0.972, P = 0.007].
ePVS may have potential for assessing the volume status of septic patients during early fluid resuscitation. The ΔePVS% during early fluid resuscitation may help to identify septic patients with a poor prognosis.
探讨基于估计血浆容量状态（ePVS）评估脓毒症患者早期液体复苏期间容量状态的可行性及预后意义。
进行一项前瞻性研究。纳入2023年3月至12月在昆明医科大学第一附属医院重症监护病房（ICU）收治的脓毒症患者。记录ICU入院时的一般信息和实验室指标，计算ePVS、序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康状况评分II（APACHE II）评分。记录液体复苏前（T0h）、液体复苏3小时（T3h）和6小时（T6h）的生命体征、动脉血气分析及容量状态相关指标。通过超声测量下腔静脉（IVC）直径及变异度，计算ePVS、估计血浆容量状态变化百分比（ΔePVS%）、中心静脉与动脉血二氧化碳分压差值（Pcv-aCO）及乳酸清除率（LCR）。根据ICU入院诊断将患者分为脓毒症组和感染性休克组，根据28天生存状态将脓毒症患者再细分为生存组和死亡组。比较各组临床资料差异。采用Spearman秩和相关检验分析早期液体复苏期间ePVS或ΔePVS%与容量状态相关指标的相关性。通过受试者工作特征曲线（ROC曲线）分析各变量对脓毒症患者28天生存的预测价值，采用Logistic回归方法分析28天死亡危险因素。
最终纳入54例脓毒症患者分析，其中脓毒症17例，感染性休克37例；28天存活34例，死亡20例，28天生存率63.0%。与脓毒症组相比，感染性休克组ICU入院时静脉ePVS较低[dL/g：4.96（3.67，7.15）vs. 7.55（4.36，10.07），P<0.05]。与死亡组相比，生存组T6h动脉和静脉ΔePVS%及白蛋白[Alb；T6h动脉ΔePVS%（%）：11.57%（-1.82%，31.35%）vs. 0.48%（-5.67%，6.02%），T6h静脉ΔePVS%：9.62%（3.59%，25.75%）vs. 1.52%（-9.65%，7.72%），Alb（g/L）：27.57±4.15 vs. 23.77±6.97，均P<0.05]较高，SOFA评分、APACHE II评分、AST、T0h Lac及T3h和T6h去甲肾上腺素用量较低[SOFA评分：9.00（8.00，10.00）vs. 11.50（9.25，14.50），APACHE II评分：18.00（14.75，21.25）vs. 25.50（21.00，30.00），AST（U/L）：34.09（23.20，56.64）vs. 79.24（25.34，196.59），T0h Lac（mmol/L）：1.75（1.40，2.93）vs. 3.25（2.33，5.30），T3h去甲肾上腺素用量（mg）：0.98（<0.01，3.10）vs. 4.60（1.05，8.55），T6h：1.82（0.38，5.30）vs. 8.20（2.80，17.73），均P<0.05]。两组复苏前后各时间点其他基础数据及ePVS差异无统计学意义。相关性分析显示，脓毒症患者T6h静脉ePVS与T6h IVC变异度呈显著正相关（r=0.360，P<0.05），T0h动脉ePVS与T3h和T6h液体入量呈显著负相关（r=-0.367，r=-0.280，均P<0.05），ICU入院时静脉ePVS与ICU入院时NT-proBNP呈显著正相关（r=0.409，P<0.05）。T6h静脉ΔePVS%与T3h液体入量及T6h LCR呈显著正相关（r=0.286，r=0.286，均P<0.05），与T6h尿量及T6h Pcv-aCO变化值（ΔPcv-aCO）呈显著负相关（r=-0.321，r=-0.371，均P<0.05）。ROC曲线分析显示，T6h静脉ΔePVS%预测脓毒症患者28天生存的ROC曲线下面积（AUC）为0.726[95%置信区间（95%CI）为0.578-0.875，P=0.006]，灵敏度为82.4%，特异度为60.0%，最佳截断值为3.09%。二元多因素Logistic回归分析显示，早期液体复苏时T6h静脉ΔePVS%升高是脓毒症患者28天死亡的保护因素[比值比（OR）=0.900，95%CI为0.834-0.972，P=0.007]。
ePVS可能有潜力评估脓毒症患者早期液体复苏期间的容量状态。早期液体复苏期间的ΔePVS%可能有助于识别预后不良的脓毒症患者。
