Measurement of central venous pressure is associated with better outcomes in septic patients: a retrospective observational study
KEYWORDS central venous pressure, sepsis, lactate, 28-day mortality 2 Abstract Purpose: With the proper insights, measurement of central venous pressure (CVP) can be a useful clinical aid. However, the formal utility of CVP measurement on mortality in septic patients has never been proved. Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) was applied to identify septic patients who had and did not have CVP measured. The primary outcome was 28-day mortality. The
... approaches including multivariate regression, propensity score matching (PSM) and an inverse probability of treatment weighing (IPTW) and causal mediation analysis (CMA) were utilized to elucidate the relationship between CVP measurement and 28-day mortality. Results: A total of 10275 patients were included in our study, of which 4516 patients (44%) had CVP measured within 24 h after ICU admission. A significant beneficial effect of CVP measurement in terms of 28-day mortality was observed (OR 0.60 (95% CI 0.51-0.70; p<0.001)). Patients in CVP group received more fluid on day 1, had a shorter duration of mechanical ventilation and vasopressor use, and the reduction of serum lactate was higher than that in the no CVP group. The mediation effect of serum lactate reduction was significant for the whole cohort (p=0.04 for average causal mediation effect (ACME)) and patients in the CVP group with an initial CVP level below 8mmHg (p=0.04 for ACME). Conclusion: CVP measurement is associated with a lower risk-adjusted 28-day mortality among patients with sepsis, which is proportionally mediated through serum lactate reduction. Intensive care medicine 2016, 42(3):458-459. 10. Legrand M, Soussi S, Depret F: Cardiac output and CVP monitoring... to guide fluid removal. Critical care (London, England) 2018, 22(1):89. 11. Vallee F, Mari A, Perner A, Vallet B: Combined analysis of cardiac output and CVP changes remains the best way to titrate fluid administration in shocked patients. Intensive care medicine 2010, 36(6):912-914. 12. Mallat J, Reddi BJ: Do not abandon monitoring the central venous pressure England) 2018, 22(1):43. 27. A, Pinsky MR, Teboul JL et al: Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive care medicine 2014, 40(12):1795-1815. 28.