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A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation. / Chandra, Jay; Armengol de la Hoz, Miguel A.; Lee, Gwendolyn; Lee, Alexandria; Thoral, Patrick; Elbers, Paul; Lee, Hyung-Chul; Munger, John S.; Celi, Leo Anthony; Kaufman, David A.

In: Critical Care, Vol. 26, No. 1, 103, 01.12.2022.

Research output: Contribution to journalArticleAcademicpeer-review

Harvard

Chandra, J, Armengol de la Hoz, MA, Lee, G, Lee, A, Thoral, P, Elbers, P, Lee, H-C, Munger, JS, Celi, LA & Kaufman, DA 2022, 'A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation', Critical Care, vol. 26, no. 1, 103. https://doi.org/10.1186/s13054-022-03968-4

APA

Chandra, J., Armengol de la Hoz, M. A., Lee, G., Lee, A., Thoral, P., Elbers, P., Lee, H-C., Munger, J. S., Celi, L. A., & Kaufman, D. A. (2022). A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation. Critical Care, 26(1), [103]. https://doi.org/10.1186/s13054-022-03968-4

Vancouver

Author

Chandra, Jay ; Armengol de la Hoz, Miguel A. ; Lee, Gwendolyn ; Lee, Alexandria ; Thoral, Patrick ; Elbers, Paul ; Lee, Hyung-Chul ; Munger, John S. ; Celi, Leo Anthony ; Kaufman, David A. / A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation. In: Critical Care. 2022 ; Vol. 26, No. 1.

BibTeX

@article{86ebe5b9a79c4db48f2f89d25e6fce9b,
title = "A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation",
abstract = "Purpose: Sepsis is a leading cause of morbidity and mortality worldwide and is characterized by vascular leak. Treatment for sepsis, specifically intravenous fluids, may worsen deterioration in the context of vascular leak. We therefore sought to quantify vascular leak in sepsis patients to guide fluid resuscitation. Methods: We performed a retrospective cohort study of sepsis patients in four ICU databases in North America, Europe, and Asia. We developed an intuitive vascular leak index (VLI) and explored the relationship between VLI and in-hospital death and fluid balance using generalized additive models (GAM). Results: Using a GAM, we found that increased VLI is associated with an increased risk of in-hospital death. Patients with a VLI in the highest quartile (Q4), across the four datasets, had a 1.61–2.31 times increased odds of dying in the hospital compared to patients with a VLI in the lowest quartile (Q1). VLI Q2 and Q3 were also associated with increased odds of dying. The relationship between VLI, treated as a continuous variable, and in-hospital death and fluid balance was statistically significant in the three datasets with large sample sizes. Specifically, we observed that as VLI increased, there was increase in the risk for in-hospital death and 36–84 h fluid balance. Conclusions: Our VLI identifies groups of patients who may be at higher risk for in-hospital death or for fluid accumulation. This relationship persisted in models developed to control for severity of illness and chronic comorbidities.",
keywords = "Fluid balance, Fluid resuscitation, Hematocrit, Mortality, Septic shock, Vascular leak",
author = "Jay Chandra and {Armengol de la Hoz}, {Miguel A.} and Gwendolyn Lee and Alexandria Lee and Patrick Thoral and Paul Elbers and Hyung-Chul Lee and Munger, {John S.} and Celi, {Leo Anthony} and Kaufman, {David A.}",
note = "Funding Information: The project was conceived, designed, and conducted during the 2019 fall course HST.953 Collaborative Data Science in Medicine at the Harvard-MIT Division of Health Science and Technology. Yueh-Hsu, Runyu Hong, Shari B. Brosnahan, John S. Munger, David A. Kaufman, and Kimiko Huang supported this research during the 2019 NYU Health Datathon. LAC is funded by the National Institutes of Health through R01 EB017205. DAK is funded by the National Institutes of Health through 1UG3HL141722-01A1 and R01HL140362. Funding Information: The project was conceived, designed, and conducted during the 2019 fall course HST.953 Collaborative Data Science in Medicine at the Harvard-MIT Division of Health Science and Technology. Yueh-Hsu, Runyu Hong, Shari B. Brosnahan, John S. Munger, David A. Kaufman, and Kimiko Huang supported this research during the 2019 NYU Health Datathon. LAC is funded by the National Institutes of Health through R01 EB017205. DAK is funded by the National Institutes of Health through 1UG3HL141722-01A1 and R01HL140362. Funding Information: Dr. Leo A. Celi was funded by the NIH through NIBIB grant R01 EB017205. Dr. David A. Kaufman is funded by the National Institutes of Health through 1UG3HL141722-01A1 and R01HL140362. Dr. Kaufman is a member of the Medical Advisory Board of Pulsion Medical Systems, has received grant support from Cheetah Medical, and serves as a consultant to FloSonics Medical. Publisher Copyright: {\textcopyright} 2022, The Author(s).",
year = "2022",
month = dec,
day = "1",
doi = "10.1186/s13054-022-03968-4",
language = "English",
volume = "26",
journal = "Critical care (London, England)",
issn = "1364-8535",
publisher = "Springer Science + Business Media",
number = "1",

}

RIS

TY - JOUR

T1 - A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation

AU - Chandra, Jay

AU - Armengol de la Hoz, Miguel A.

AU - Lee, Gwendolyn

AU - Lee, Alexandria

AU - Thoral, Patrick

AU - Elbers, Paul

AU - Lee, Hyung-Chul

AU - Munger, John S.

AU - Celi, Leo Anthony

AU - Kaufman, David A.

N1 - Funding Information: The project was conceived, designed, and conducted during the 2019 fall course HST.953 Collaborative Data Science in Medicine at the Harvard-MIT Division of Health Science and Technology. Yueh-Hsu, Runyu Hong, Shari B. Brosnahan, John S. Munger, David A. Kaufman, and Kimiko Huang supported this research during the 2019 NYU Health Datathon. LAC is funded by the National Institutes of Health through R01 EB017205. DAK is funded by the National Institutes of Health through 1UG3HL141722-01A1 and R01HL140362. Funding Information: The project was conceived, designed, and conducted during the 2019 fall course HST.953 Collaborative Data Science in Medicine at the Harvard-MIT Division of Health Science and Technology. Yueh-Hsu, Runyu Hong, Shari B. Brosnahan, John S. Munger, David A. Kaufman, and Kimiko Huang supported this research during the 2019 NYU Health Datathon. LAC is funded by the National Institutes of Health through R01 EB017205. DAK is funded by the National Institutes of Health through 1UG3HL141722-01A1 and R01HL140362. Funding Information: Dr. Leo A. Celi was funded by the NIH through NIBIB grant R01 EB017205. Dr. David A. Kaufman is funded by the National Institutes of Health through 1UG3HL141722-01A1 and R01HL140362. Dr. Kaufman is a member of the Medical Advisory Board of Pulsion Medical Systems, has received grant support from Cheetah Medical, and serves as a consultant to FloSonics Medical. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12/1

Y1 - 2022/12/1

N2 - Purpose: Sepsis is a leading cause of morbidity and mortality worldwide and is characterized by vascular leak. Treatment for sepsis, specifically intravenous fluids, may worsen deterioration in the context of vascular leak. We therefore sought to quantify vascular leak in sepsis patients to guide fluid resuscitation. Methods: We performed a retrospective cohort study of sepsis patients in four ICU databases in North America, Europe, and Asia. We developed an intuitive vascular leak index (VLI) and explored the relationship between VLI and in-hospital death and fluid balance using generalized additive models (GAM). Results: Using a GAM, we found that increased VLI is associated with an increased risk of in-hospital death. Patients with a VLI in the highest quartile (Q4), across the four datasets, had a 1.61–2.31 times increased odds of dying in the hospital compared to patients with a VLI in the lowest quartile (Q1). VLI Q2 and Q3 were also associated with increased odds of dying. The relationship between VLI, treated as a continuous variable, and in-hospital death and fluid balance was statistically significant in the three datasets with large sample sizes. Specifically, we observed that as VLI increased, there was increase in the risk for in-hospital death and 36–84 h fluid balance. Conclusions: Our VLI identifies groups of patients who may be at higher risk for in-hospital death or for fluid accumulation. This relationship persisted in models developed to control for severity of illness and chronic comorbidities.

AB - Purpose: Sepsis is a leading cause of morbidity and mortality worldwide and is characterized by vascular leak. Treatment for sepsis, specifically intravenous fluids, may worsen deterioration in the context of vascular leak. We therefore sought to quantify vascular leak in sepsis patients to guide fluid resuscitation. Methods: We performed a retrospective cohort study of sepsis patients in four ICU databases in North America, Europe, and Asia. We developed an intuitive vascular leak index (VLI) and explored the relationship between VLI and in-hospital death and fluid balance using generalized additive models (GAM). Results: Using a GAM, we found that increased VLI is associated with an increased risk of in-hospital death. Patients with a VLI in the highest quartile (Q4), across the four datasets, had a 1.61–2.31 times increased odds of dying in the hospital compared to patients with a VLI in the lowest quartile (Q1). VLI Q2 and Q3 were also associated with increased odds of dying. The relationship between VLI, treated as a continuous variable, and in-hospital death and fluid balance was statistically significant in the three datasets with large sample sizes. Specifically, we observed that as VLI increased, there was increase in the risk for in-hospital death and 36–84 h fluid balance. Conclusions: Our VLI identifies groups of patients who may be at higher risk for in-hospital death or for fluid accumulation. This relationship persisted in models developed to control for severity of illness and chronic comorbidities.

KW - Fluid balance

KW - Fluid resuscitation

KW - Hematocrit

KW - Mortality

KW - Septic shock

KW - Vascular leak

UR - http://www.scopus.com/inward/record.url?scp=85128040861&partnerID=8YFLogxK

U2 - 10.1186/s13054-022-03968-4

DO - 10.1186/s13054-022-03968-4

M3 - Article

C2 - 35410278

VL - 26

JO - Critical care (London, England)

JF - Critical care (London, England)

SN - 1364-8535

IS - 1

M1 - 103

ER -

ID: 23143886