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Admission Peripheral Edema, Central Venous Pressure, and Survival in Critically Ill Patients.
Ann Am Thorac Soc. 2016 Mar 11;
Authors: Danziger J, Chen K, Cavender S, Lee J, Feng M, Mark RG, Mukamal KJ, Celi LA
Abstract
RATIONALE: The clinical significance of peripheral edema has not been well described in critical illness.
OBJECTIVES: To assess the clinical significance of peripheral edema detected on physical examination at the time of hospital admission for patients who were treated in an intensive care unit (ICU).
METHODS: Using a large inception cohort of critically ill patients, we examined the association of peripheral edema as documented on hospital admission physical examination with hospital and 1- year survival.
MEASUREMENTS AND MAIN RESULTS: Of 12,778 patients admitted to an intensive care unit (ICU) at a teaching hospital in Boston, Massachusetts, 2338(18%) had peripheral edema. Adjusting for severity of illness and comorbidities, including pulmonary edema, admission peripheral edema was associated with a 26% (95%CI 1.11-1.44, p<0.001) higher risk of hospital mortality. In those patients whose peripheral edema could be graded, trace, 1+,2+ and 3+ admission peripheral edema was associated with a 2% (95%CI 0.80-1.31, p=0.89), 17% (95%CI1.00-1.56, p=0.05), 60% (95%CI 1.26-2.04, p<0.001) and 54% (95%CI 1.04-2.29, p=0.03) higher adjusted risk of hospital mortality, respectively, compared to edema-free patients. The association was consistent across strata of patients with diabetes, congestive heart failure, sepsis, and pre-morbid diuretic or calcium channel blocker use. In a subset of patients with central venous pressures (CVP) measurements obtained within six hours of ICU admission, the highest CVP quartile (>13 cm H20) was similarly associated with a 35% (95%CI 1.05-1.75, p=0.02) higher adjusted risk of hospital mortality compared to the lowest quartile (≤ 7 cm H20).
CONCLUSION: Peripheral edema as detected on physical examination at the time of hospital admission is a poor prognostic indicator in critical illness. Whether peripheral edema simply reflects underlying pathophysiology, or has an independent pathogenic role, will require further interventional studies.
PMID: 26966784 [PubMed - as supplied by publisher]