Entrar/Registro  
HOME SPANISH
 
Medicina Crítica
   
MENU

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board






>Journals >Medicina Crítica >Year 2018, Issue 3


Palacios MP, Domínguez BA, Camarena AG, Aguirre SJS, Franco GJ
Capillary leak index as a new prognostic tool in septic shock
Rev Asoc Mex Med Crit y Ter Int 2018; 32 (3)

Language: Español
References: 21
Page: 141-146
PDF: 176.74 Kb.


Full text




ABSTRACT

Introduction: The leak syndrome in sepsis is a serious condition that causes increased mortality. For this reason, the validation of forecast tools that facilitate the stratification of severity and that lead to an adequate treatment is essential. The capillary leakage index (CLI) will allow predicting the outcome in these patients, as well as improving control in resuscitation and decreasing mortality.
Material and methods: A two centered observational, comparative, longitudinal, prospective study was realized. We include patients diagnosed with severe sepsis and septic shock, performed in 2 phases (generation and validation). In the first phase we registered CLI (capillary leak index), SOFA, APACHE, CRP, albumin, hospital stay days and in-hospital mortality. t Student and ROC curves were used to validate CLI as a bad outcome (cut-off-point 85.55). In the second phase the cut-of-point of the first phase was analyzed and compares with before mentioned variables to validate it as an outcome scale.
Results: 116 patients were included. An analysis with ROC curve was developed in the generation phase (n = 62), where the cut-off point (85.55, ABC 0.88) was obtained as the best predictor of mortality. In the second phase, the group was analyzed according to the cut point generated in the first phase. Consequently, a sensibility of 100%, specificity of 89%, positive predictive value of 67% and a negative predictive value of 100% were obtained. A Kaplan-Maier curve and a Log Rank test were realized in the second group comparing expected mortality in 28 days according to the cut-of-point of CLI ‹ 85.55, confirming a survival rate of 88.6% against 20.0%, hence a significant statistic between groups (p ‹ 0.001).
Conclusions: CLI is a favorable tool for predicting a poor outcome in patients with septic shock. The cut-off-point (85.55) for CLI provides the best sensibility and specificity. In consequence CLI is an index that can be easily examined at the bedside of the patient; making this a low-cost, simple and affordable test.


Key words: Capillary leak index, septic shock.


REFERENCIAS

  1. Chang HJ, Lynm C, Glass RM. Sepsis. JAMA. 2010;304(16):1856.

  2. Zapata OJ. Sepsis: la otra cara de la respuesta inmune. Iatreia. 2011;24:179-190.

  3. Nduka O, Parrillo JE. The pathophysiology of septic shock. Crit Care Clin. 2009;25(4):677-702.

  4. Cordemans C, De laet I, Van Regenmortel N, Schoonheydt K, Dits H, Huber W, Malbrain ML. Fluid management in critically ill patients: The role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Ann Intensive Care. 2012;2(Suppl 1):S1.

  5. De Backer D, Orbegozo Cortes, Donadello K, Vincent JL. Pathophysiology of microcirculatory dysfunction and pathogenesis of septic shock. Virulence. 2014;5(1):73-79.

  6. Paulus P, Jennewein C, Zacharowski K. Biomarkers of endothelial dysfunction: can they help us deciphering systemic inflammation and sepsis. Biomarkers. 2011;16(Suppl 1):S11-21.

  7. Krüttgen A, Rose-John S. Interleukin-6 in sepsis and capillary leakage syndrome. J Interferon Cytokine Res. 2012;32(2):60-65.

  8. Lee WL, Slutsky AS. Sepsis and endothelial permeability. N Engl J Med. 2010;363(7):689-691.

  9. Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369:1243-1251.

  10. Salmon AH, Satchell SC. Endothelial glycocalyx dysfunction in disease: albuminuria and increased microvascular permeability. J Pathol. 2012;226(4):562-574.

  11. Enghard P, Rademacher S, Nee J, Hasper D, Engert U, Jörres A, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care. 2015;19:36.

  12. Talmor D, Greenberg D, Howell MD, Lisbon A, Novack V, Shapiro N. The costs and cost-effectiveness of an integrated sepsis treatment protocol. Crit Care Med. 2008;36(4):1168-1174.

  13. Vincent JL, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet. 2013;381(9868):774-775.

  14. Kaukonen KM, Bailey M, Pilcher D, Jaime CD, Bellomo R. Systemic Inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372:1629-1638.

  15. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines on the management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637.

  16. Carrillo-Esper R, Carrillo-Córdova JR, Carrillo-Córdova LD. Estudio epidemiológico de sepsis en unidades de terapia intensiva mexicanas. Cir Cir. 2009;77(4):301-308.

  17. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-829.

  18. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5(1):4-11.

  19. Opal SM, Van der Poll T. Endothelial barrier dysfunction in septic shock. J Intern Med. 2015;277(3):277-293.

  20. Chelazzi C, Villa G, Mancinelli P, De Gaudio R, Adembri C. Glicocalix and sepsis-induced alterations in vascular permeability. Crit Care. 2015;19:26.

  21. Levy MM. Early goal-directed therapy: what do we now? Crit Care. 2014;18(6):705.






>Journals >Medicina Crítica >Year 2018, Issue 3
 

· Journal Index 
· Links 






       
Copyright 2019