Estimated plasma volume status can help identify patients with sepsis at risk of death within 30 days in the emergency department


Submitted: 11 August 2023
Accepted: 13 October 2023
Published: 20 October 2023
Abstract Views: 536
PDF: 121
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Gianni Turcato Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy.
  • Arian Zaboli Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy. https://orcid.org/0000-0002-4204-8884
  • Serena Sibilio Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy; Teaching hospital of Paracelsus Medical Private University, Salzburg, Austria.
  • Michael Mian Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano; Teaching hospital of Paracelsus Medical Private University, Salzburg, Austria; College of Health Care-Professions Claudiana, Bozen, Italy.
  • Francesco Brigo Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.

For patients with sepsis in the Emergency Department (ED), early risk stratification is important to improve prognosis. The study aimed to evaluate the predictive role of estimated plasma volume (ePVS) on admission to the ED. All sepsis patients who were admitted to our ED in 2021, were included in this prospective study. Multivariate models adjusted for patients' clinical characteristics were used to assess the contribution of ePVS to the independent prediction of death at 30 days. A total of 455 septic patients were enrolled and 16.9% of patients died. Patients who survived to 30 days had a mean ePVS of 5.19, while those who died at 30 days had a value of 5.74 (p=0.004). ePVS was an independent risk factor for 30-day mortality with an adjusted OR of 1.211 (95% CI 1.004–1.460, p=0.045). The AUROC of ePVS was 0.619 (95% CI 0.545–0.689). Decision tree analysis showed a predictive role for ePVS in less severe patients. In septic patients, ePVS is an independent predictor of 30-day mortality and may improve risk prediction in less severe patients.


Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47:1181-1247. DOI: https://doi.org/10.1007/s00134-021-06506-y

Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet 2018;392:75-87. DOI: https://doi.org/10.1016/S0140-6736(18)30696-2

Ince C, Mayeux PR, Nguyen T, et al. The endothelium in sepsis. Shock 2016;45:259-270. DOI: https://doi.org/10.1097/SHK.0000000000000473

Joffre J, Hellman J, Ince C, Ait-Oufella H. Endothelial Responses in Sepsis. Am J Respir Crit Care Med 2020;202:361-370. DOI: https://doi.org/10.1164/rccm.201910-1911TR

Andrews B, Semler MW, Muchemwa L, et al. Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension: A Randomized Clinical Trial. JAMA 2017;318:1233-1240. DOI: https://doi.org/10.1001/jama.2017.10913

Macdonald SPJ, Keijzers G, Taylor DM, et al. Restricted fluid resuscitation in suspected sepsis associated hypotension (REFRESH): a pilot randomised controlled trial. Intensive Care Med 2018;44:2070-2078. DOI: https://doi.org/10.1007/s00134-018-5433-0

Corradi F, Via G, Tavazzi G. What's new in ultrasound-based assessment of organ perfusion in the critically ill: expanding the bedside clinical monitoring window for hypoperfusion in shock. Intensive Care Med 2020;46:775–779. DOI: https://doi.org/10.1007/s00134-019-05791-y

Corradi F, Brusasco C, Via G, et al. Renal Doppler-Based Assessment of Regional Organ Perfusion in the Critically Ill Patient. Shock (Augusta, Ga.) 2021;55:842–843. DOI: https://doi.org/10.1097/SHK.0000000000001571

Tavazzi G, Spiegel R, Rola P, et al. Multiorgan evaluation of perfusion and congestion using ultrasound in patients with shock. European heart journal. Acute Cardiovasc Care 2023;12:344–352. DOI: https://doi.org/10.1093/ehjacc/zuad025

Tavazzi G, Corradi F, Vandenbriele C, Alviar CL. Multimodality imaging in cardiogenic shock: state-of-the art. Curr Opinion Critical Care 2023;29:381–391. DOI: https://doi.org/10.1097/MCC.0000000000001068

Iba T, Levy JH. Derangement of the endothelial glycocalyx in sepsis. J Thromb Haemost 2019;17:283-294. DOI: https://doi.org/10.1111/jth.14371

Kim KH, Cho HJ, Kim SC, Lee J. Prognostic value of estimated plasma volume status in patients with sepsis. J Korean Med Sci 2022;37:e145. DOI: https://doi.org/10.3346/jkms.2022.37.e145

Duarte K, Monnez JM, Albuisson E, et al. Prognostic Value of Estimated Plasma Volume in Heart Failure. JACC Heart Fail 2015;3:886-893. DOI: https://doi.org/10.1016/j.jchf.2015.06.014

Kobayashi M, Girerd N, Duarte K, et al. Estimated plasma volume status in heart failure: clinical implications and future directions. Clin Res Cardiol 2021;110:1159-1172. DOI: https://doi.org/10.1007/s00392-020-01794-8

Turcato G, Zaboli A, Ciccariello L, Pfeifer N. Estimated plasma volume status (ePVS) could be an easy-to-use clinical tool to determine the risk of sepsis or death in patients with fever. J Crit Care 2020;58:106-112. DOI: https://doi.org/10.1016/j.jcrc.2020.05.001

Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-810. DOI: https://doi.org/10.1001/jama.2016.0287

Turcato G, Zaboli A, Pfeifer N, et al. Decision tree analysis to predict the risk of intracranial haemorrhage after mild traumatic brain injury in patients taking DOACs. Am J Emerg Med 2021;50:388-393. DOI: https://doi.org/10.1016/j.ajem.2021.08.048

Malbrain ML, Marik PE, Witters I, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther 2014;46:361-380. DOI: https://doi.org/10.5603/AIT.2014.0060

Dodd RL, Archambault ME. Preventing kidney injury by avoiding fluid overload in patients with sepsis. JAAPA 2019;32:40-45. DOI: https://doi.org/10.1097/01.JAA.0000604904.81228.18

Meyhoff TS, Wichmann S, Messmer AS. Editorial: Fluid overload in the critically ill. Front Med (Lausanne) 2023;10:1166202. DOI: https://doi.org/10.3389/fmed.2023.1166202

Chen J, Shen J, Cai D, et al. Estimated plasma volume status (ePVS) is a predictor for acute myocardial infarction in-hospital mortality: analysis based on MIMIC-III database. BMC Cardiovasc Dis 2021;21:530. DOI: https://doi.org/10.1186/s12872-021-02338-2

Chouihed T, Rossignol P, Bassand A, et al. Diagnostic and prognostic value of plasma volume status at emergency department admission in dyspneic patients: results from the PARADISE cohort. Clin Res Cardiol 2019;108:563-573. DOI: https://doi.org/10.1007/s00392-018-1388-y

Turcato G, Zaboli A, Pfeifer N. The COVID-19 epidemic and reorganisation of triage, an observational study. Intern Emerg Med 2020;15:1517-1524. DOI: https://doi.org/10.1007/s11739-020-02465-2

Turcato, G., Zaboli, A., Sibilio, S., Mian, M., & Brigo, F. (2023). Estimated plasma volume status can help identify patients with sepsis at risk of death within 30 days in the emergency department. Emergency Care Journal, 19(4). https://doi.org/10.4081/ecj.2023.11655

Downloads

Download data is not yet available.

Citations