Skip to main content

Advertisement

SpringerLink
Log in

Extravascular lung water index and Halperin score to predict outcome in critically ill patients

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Objective

The aim of this study was to describe real world extravascular lung water index (EVLWI) measurements obtained by pulse index continuous cardiac output (PiCCO) on the day of admission. These were then related to a radiologic score for lung edema, Halperin score and both the Halperin score and EVLWI were assessed for prediction of in-hospital mortality in critically ill patients.

Methods and results

A total of 311 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis and of these 177 patients were intubated. In-hospital mortality was assessed by logistic regression. In the overall cohort, EVLWI and the Halperin score correlated poorly (r = 0.17; p = 0.02). In intubated patients, EVLWI and Halperin score did not correlate (r = 0.09; p = 0.39), whereas in patients who were not intubated there was a moderate association (r = 0.30; p = 0.007).

In the overall cohort, (a) EVLWI (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.02–1.19; p = 0.01; area under the curve [AUC] 0.63, 95% CI 0.54–0.71) but not (b) Halperin score (HR 1.00, 95% CI 0.996–1.004; p = 0.94; AUC 0.52, 95% CI 0.45–0.58) was associated with in-hospital mortality There was a robust association of EVLWI (HR 1.12, 95% CI 1.01–1.25; p = 0.03) but not Halperin score (HR 1.003, 95% CI 0.997–1.009; p = 0.30) with mortality in non-intubated patients. In intubated patients, neither EVLWI (HR 0.997 95% CI 0.990–1.003; p = 0.33) nor Halperin score (HR 1.08; 95% CI 0.88–1.32; p = 0.47) was associated with mortality.

Conclusion

The EVLWI correlated moderately with a radiologic score for lung edema, the Halperin score, in non-intubated but not in intubated patients. The EVLWI at admission was associated with in-hospital mortality in our patient collective of critically ill patients and might constitute not only a tool for risk stratification but most importantly a valuable treatment goal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CO:

Cardiac output

CVP:

Central venous pressure

EVLWI:

Extravascular lung water index

GEDVI:

Global end-diastolic volume index

ICU:

Intensive care unit

ITBVI:

Intrathoracic blood volume index

PAC:

Pulmonary artery catheter

PICCO:

Pulse index continuous cardiac output

SVRI:

Systemic vascular resistance index

References

  1. Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;283(9):447–51. https://doi.org/10.1056/nejm197008272830902. Epub 1970/08/27.

    Article  PubMed  CAS  Google Scholar 

  2. Kirton OC, Calabrese RC, Staff I. Increasing use of less-invasive hemodynamic monitoring in 3 specialty surgical intensive care units: a 5-year experience at a tertiary medical center. J Intensive Care Med. 2015;30(1):30–6. https://doi.org/10.1177/0885066613498055. Epub 2013/08/14.

    Article  PubMed  Google Scholar 

  3. Wernly B, Lichtenauer M, Franz M, Fritzenwanger M, Kabisch B, Figulla HR, et al. Pulse contour cardiac output monitoring in acute heart failure patients : assessment of hemodynamic measurements. Wien Klin Wochenschr. 2016;128(23/24):864–9. https://doi.org/10.1007/s00508-016-1048-z. PubMed PMID: 27525745; PubMed Central PMCID: PMCPMC5161758.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ritter S, Rudiger A, Maggiorini M. Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study. Crit Care. 2009;13(4):R133. https://doi.org/10.1186/cc7994. Epub 2009/08/13.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Oren-Grinberg A. The PiCCO Monitor. Int Anesthesiol Clin. 2010;48(1):57–85. https://doi.org/10.1097/AIA.0b013e3181c3dc11. Epub 2010/01/13.

    Article  PubMed  Google Scholar 

  6. Litton E, Morgan M. The PiCCO monitor: a review. Anaesth Intensive Care. 2012;40(3):393–409. Epub 2012/05/15.

    PubMed  CAS  Google Scholar 

  7. Cottis R, Magee N, Higgins DJ. Haemodynamic monitoring with pulse-induced contour cardiac output (PiCCO) in critical care. Intensive Crit Care Nurs. 2003;19(5):301–7. Epub 2003/10/01.

    Article  PubMed  Google Scholar 

  8. Jozwiak M, Silva S, Persichini R, Anguel N, Osman D, Richard C, et al. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress syndrome. Crit Care Med. 2013;41(2):472–80. https://doi.org/10.1097/CCM.0b013e31826ab377. Epub 2012/12/25.

    Article  PubMed  Google Scholar 

  9. Kuzkov VV, Kirov MY, Sovershaev MA, Kuklin VN, Suborov EV, Waerhaug K, et al. Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury. Crit Care Med. 2006;34(6):1647–53. https://doi.org/10.1097/01.ccm.0000218817.24208.2e. Epub 2006/04/21.

    Article  PubMed  Google Scholar 

  10. Wang ZY, Bai Y. Extravascular lung water and pulmonary vascular permeability index may inadvertently delay the identification of acute respiratory distress syndrome. Crit Care. 2013;17(2):420. https://doi.org/10.1186/cc12542. PubMed PMID: 23522053; PubMed Central PMCID: PMCPMC3672491.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wang H, Cui N, Su L, Long Y, Wang X, Zhou X, et al. Prognostic value of extravascular lung water and its potential role in guiding fluid therapy in septic shock after initial resuscitation. J Crit Care. 2016;33:106–13. https://doi.org/10.1016/j.jcrc.2016.02.011. PubMed PMID: 27021852.

    Article  PubMed  Google Scholar 

  12. Gassanov N, Caglayan E, Nia A, Erdmann E, Er F. Hemodynamic monitoring in the intensive care unit: pulmonary artery catheter versus PiCCO. Dtsch Med Wochenschr. 2011;136(8):376–80. https://doi.org/10.1055/s-0031-1272539. PubMed PMID: 21332037.

    Article  PubMed  CAS  Google Scholar 

  13. Halperin BD, Feeley TW, Mihm FG, Chiles C, Guthaner DF, Blank NE. Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest. 1985;88(5):649–52. PubMed PMID: 3902385.

    Article  PubMed  CAS  Google Scholar 

  14. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981;9(8):591–7. Epub 1981/08/01.

    Article  PubMed  CAS  Google Scholar 

  15. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/north American multicenter study. J Am Med Assoc. 1993;270(24):2957–63. Epub 1993/12/22.

    Article  Google Scholar 

  16. Mutoh T, Kazumata K, Ajiki M, Ushikoshi S, Terasaka S. Goal-directed fluid management by bedside transpulmonary hemodynamic monitoring after subarachnoid hemorrhage. Stroke. 2007;38(12):3218–24. https://doi.org/10.1161/strokeaha.107.484634. Epub 2007/11/10.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria

    Bernhard Wernly, Michael Lichtenauer & Uta C. Hoppe

  2. Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany

    Sebastian Haumann & Diane Renz

  3. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany

    Maryna Masyuk, Johanna Muessig, Malte Kelm, Ralf Westenfeld &  Christian Jung M.D. PhD

  4. Cardiovascular Research Institute Duesseldorf (CARID), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Duesseldorf, Germany

    Maryna Masyuk, Johanna Muessig, Malte Kelm, Ralf Westenfeld &  Christian Jung M.D. PhD

  5. Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany

    Laura Bäz, Marcus Franz & Paul Christian Schulze

  6. Clinic of Internal Medicine III, Jena University Hospital, Jena, Germany

    Alexander Pfeil

  7. Department of Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Alexander Lauten

  8. Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany

    Alexander Lauten

Authors
  1. Bernhard Wernly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian Haumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maryna Masyuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johanna Muessig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Lichtenauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Laura Bäz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marcus Franz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alexander Pfeil
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alexander Lauten
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Paul Christian Schulze
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Uta C. Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Malte Kelm
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ralf Westenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Christian Jung M.D. PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Diane Renz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Jung M.D. PhD.

Ethics declarations

Conflict of interest

B. Wernly, S. Haumann, M. Masyuk, J. Muessig, M. Lichtenauer, L. Bäz, M. Franz, A. Pfeil, A. Lauten, P.C. Schulze, U.C. Hoppe, M. Kelm, R. Westenfeld, C. Jung, and D. Renz declare that they have no competing interests.

Ethical standards

The study was approved by the local ethics committee of Jena University Hospital and the Medical Faculty of the Friedrich Schiller University of Jena. The local ethics committee of Jena University Hospital waived the need to obtain written informed consent to participate from the patients involved in this study, as the data were collected retrospectively.

Additional information

Availability of supporting data

All data relevant for this study will be given by the authors upon specific request without restriction.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wernly, B., Haumann, S., Masyuk, M. et al. Extravascular lung water index and Halperin score to predict outcome in critically ill patients. Wien Klin Wochenschr 130, 505–510 (2018). https://doi.org/10.1007/s00508-018-1370-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-018-1370-8

Keywords

Search

Navigation