Capillary Albumin Transudation Rate and Outcome in Critically Ill Subjects Stephanie Yan, MD, Colin Doyle, MD, David Inouye, MD, Scott Harvey, MD, Michael.

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Presentation transcript:

Capillary Albumin Transudation Rate and Outcome in Critically Ill Subjects Stephanie Yan, MD, Colin Doyle, MD, David Inouye, MD, Scott Harvey, MD, Michael Hayashi, MD, Richard Severino, PhD, Danny Takanishi, MD, Frank Zhao, MD, Mihae Yu, MD Department of Surgery Division of Surgical Critical Care, University of Hawaii Queen’s Medical Center PRESENTED AT:

DISCLOSURES We have nothing to disclose

INTRODUCTION Capillary leakage in inflammatory statesmulti-organ dysfunction Albumin transudation rate- a surrogate measurement for capillary leakage AIM OF STUDY: relationship between persistently elevated albumin transudation rate and mortality

A slope of >0.25%= increased capillary permeability Blood Volume Analysis A slope of >0.25%= increased capillary permeability

METHODS Retrospective study on subjects with blood volume analysis, 2010 to 2014 Subjects with at least 3 blood volume measurements within 14 days while in the SICU Persistent transudation rate was defined as a value greater than 0.25% more than 33% of the time during the study period Chi-square Multivariate logistic regression : persistently high leak rate on mortality while controlling for APACHE II scores

RESULTS: Group Characteristics Persistent High Leak Rate N=55 Normal Leak Rate N=109 p-value Sex (F:M) 17(31%) : 38(69%) 43(39%) : 66(61%) p=0.2837 Age 66 ± 17 65 ± 16 p=0.7414 APACHE II 25 ± 6 23 ± 6 p=0.0804 Lactate 3.4 ± 2.8 3.0 ± 2.3 p=0.4203 Hospital LOS 29 ± 25 39 ± 30 p=0.0030 Mortality (Survivors:Non-Survivors) 32(58%) : 23(42%) 83(76%) : 26(24%) p=0.0176 Severe sepsis 37(67%) 64(59%) p=0.2875 Septic shock 28(51%) 50(46%) p=0.5419 Cardiogenic shock 12(22%) 17(16%) p=0.3241 Hemorrhagic shock 5(9%) 9(8%) p=0.8568 Respiratory failure 39(71%) 75(69%) p=0.7825

RESULTS: by Mortality Survivors (n=115) Non-Survivors (n=49) p-value Persistent High Leak Rate 32 (28%) 23 (47%) p=0.0176 APACHE II 23 ± 6 26± 6.0 p=0.0086 Lactate 3.3 ± 2.5 2.8 ± 2.2 p=0.2047 Age 63 ± 17 71 ± 15 p=0.0025 LOS 40 ± 27 25 ± 29 p<0.0001 Severe sepsis 67(58%) 34(69%) p=0.1799 Septic shock 53(46%) 25(51%) p=0.5625 Cardiogenic shock 18(16%) 11(22%) p=0.2964 Hemorrhagic shock 8(7%) 6(12%) p=0.2673 Respiratory failure 81(70%) 33(67%) p=0.6942

RESULTS: Odds Ratio for Mortality Effect Odds Ratio 95% Confidence Limits APACHE II Score 1.08 1.02 1.15 Persistent High Leak 2.15 1.05 4.38 Logistic regression modeling (taking into account APACHE II scores) presence of a persistent high leak is predictive of mortality Odds of dying = 2 times greater when a persistent high leak is present while controlling for APACHE II score Persistently high leak rate has greater effect on mortality than the APACHE II score

CONCLUSIONS Sparse data evaluating albumin transudation rate in clinical settings due to limited technology Persistently elevated albumin transudation rate associated with higher mortality Albumin transudation rate, as a point of care assay, an early clinical tool used to guide treatment and measure response to interventions

REFERENCES Joseph Feldschuh, MD. Capillary Transudation and Albumin Slope in Evaluating Capillary “Leaks”. Civetta, Taylor, & Kirby’s Critical Care, Fourth Ed., Andrea Gabrielli, A. Joseph Layon, Mihae Yu Scott Harvey, MD, et al. Persistently High Albumin Leak is Associated with Mortality. Critical Care Medicine 2014 Vol 42, No.60 Parlngemar Johansson, et al. Shock Induced Endotheliopathy (SHINE) in acute critical illness- a unifying pathophysiologic mechanism. Critical Care 2017 21:25 Timothy A. Manzone, et al. Blood Volume Analysis: A New Technique and New Clinical Interest Reinvigorate a Classic Study. Journal of Nuclear Medicine June 2007 Vol 35 No.2 Marc Pineton de Chambrun, MD, MSc, et al. The Clinical Picture of Severe Systemic Capillary-Leak Syndrome Episodes Requiring ICU Admission. Society of Critical Care Medicine, July 2017 Vol 45, No.7 Tecelucksingh S, Padfield PL, Edwards CR: Systemic capillary leak syndrome. QJ Med 75:515-524, 1990 Peter Tassani, MD, et al. Extravasation of Albumin after Cardiopulmonary Bypass in Newborns. Journal of Cardiothoracic and Vascular Anesthesia, Vol 21, No 2 (April), 2007:pp 174-178 Mihae Yu, MD, et al. A Prospective Randomized Trial Using Blood Volume Analysis in Addition to Pulmonary Artery Catheter, Compared with Pulmonary Artery Catheter Alone, to Guide Shock Resuscitation in Critically Ill Surgical Patients. Shock, Vol. 35, No. 3, pp. 220Y228, 2011