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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Acute Kidney Injury | Research

Central venous pressure measurement is associated with improved outcomes in septic patients: an analysis of the MIMIC-III database

Authors: Hui Chen, Zhu Zhu, Chenyan Zhao, Yanxia Guo, Dongyu Chen, Yao Wei, Jun Jin

Published in: Critical Care | Issue 1/2020

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Abstract

Purpose

Measurement of central venous pressure (CVP) can be a useful clinical tool. However, the formal utility of CVP measurement in preventing mortality in septic patients has never been proven.

Methods

The Medical Information Mart for Intensive Care III (MIMIC-III) database was searched to identify septic patients with and without CVP measurements. The primary outcome was 28-day mortality. Multivariate regression was used to elucidate the relationship between CVP measurement and 28-day mortality, and propensity score matching (PSM) and an inverse probability of treatment weighing (IPTW) were employed to validate our findings.

Results

A total of 10,275 patients were included in our study, of which 4516 patients (44%) underwent CVP measurement within 24 h of intensive care unit (ICU) admission. The risk of 28-day mortality was reduced in the CVP group (OR 0.60 (95% CI 0.51–0.70; p < 0.001)). Patients in the CVP group received more fluid on day 1 and had a shorter duration of mechanical ventilation and vasopressor use, and the reduction in serum lactate was greater than that in the no CVP group. The mediating effect of serum lactate reduction was significant for the whole cohort (p = 0.04 for the average causal mediation effect (ACME)) and patients in the CVP group with an initial CVP level below 8 mmHg (p = 0.04 for the ACME).

Conclusion

CVP measurement was associated with decreased risk-adjusted 28-day mortality among patients with sepsis and was proportionally mediated through serum lactate reduction.
Appendix
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Metadata
Title
Central venous pressure measurement is associated with improved outcomes in septic patients: an analysis of the MIMIC-III database
Authors
Hui Chen
Zhu Zhu
Chenyan Zhao
Yanxia Guo
Dongyu Chen
Yao Wei
Jun Jin
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03109-9

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