1. 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:

2. DISCLOSURES
We have nothing to disclose

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. REFERENCES
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Scott Harvey, MD, et al. Persistently High Albumin Leak is Associated with Mortality. Critical Care Medicine 2014 Vol 42, No.60
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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
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