Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis
Journal
Critical Care
ISSN
1364-8535
Date Issued
2022
Author(s)
Francesco Gavelli
Rui Shi
Jean-Louis Teboul
Danila Azzolina
Mathieu Jozwiak
Michelle S. Chew
Wolfgang Huber
Mikhail Y. Kirov
Vsevolod V. Kuzkov
Tobias Lahmer
Manu L. N. G. Malbrain
Jihad Mallat
Samir G. Sakka
Takashi Tagami
Tài Pham
Xavier Monnet
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>The prognostic value of extravascular lung water (EVLW) measured by transpulmonary thermodilution (TPTD) in critically ill patients is debated. We performed a systematic review and meta-analysis of studies assessing the effects of TPTD-estimated EVLW on mortality in critically ill patients.
</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Cohort studies published in English from Embase, MEDLINE, and the Cochrane Database of Systematic Reviews from 1960 to 1 June 2021 were systematically searched. From eligible studies, the values of the odds ratio (OR) of EVLW as a risk factor for mortality, and the value of EVLW in survivors and non-survivors were extracted. Pooled OR were calculated from available studies. Mean differences and standard deviation of the EVLW between survivors and non-survivors were calculated. A random effects model was computed on the weighted mean differences across the two groups to estimate the pooled size effect. Subgroup analyses were performed to explore the possible sources of heterogeneity.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>Of the 18 studies included (1296 patients), OR could be extracted from 11 studies including 905 patients (464 survivors vs. 441 non-survivors), and 17 studies reported EVLW values of survivors and non-survivors, including 1246 patients (680 survivors vs. 566 non-survivors). The pooled OR of EVLW for mortality from eleven studies was 1.69 (95% confidence interval (CI) [1.22; 2.34], <jats:italic>p</jats:italic> < 0.0015). EVLW was significantly lower in survivors than non-survivors, with a mean difference of −4.97 mL/kg (95% CI [−6.54; −3.41], <jats:italic>p</jats:italic> < 0.001). The results regarding OR and mean differences were consistent in subgroup analyses.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>The value of EVLW measured by TPTD is associated with mortality in critically ill patients and is significantly higher in non-survivors than in survivors. This finding may also be interpreted as an indirect confirmation of the reliability of TPTD for estimating EVLW at the bedside. Nevertheless, our results should be considered cautiously due to the high risk of bias of many studies included in the meta-analysis and the low rating of certainty of evidence.</jats:p>
<jats:p><jats:italic>Trial registration</jats:italic> the study protocol was prospectively registered on PROSPERO: CRD42019126985.</jats:p>
</jats:sec>
<jats:title>Background</jats:title>
<jats:p>The prognostic value of extravascular lung water (EVLW) measured by transpulmonary thermodilution (TPTD) in critically ill patients is debated. We performed a systematic review and meta-analysis of studies assessing the effects of TPTD-estimated EVLW on mortality in critically ill patients.
</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Cohort studies published in English from Embase, MEDLINE, and the Cochrane Database of Systematic Reviews from 1960 to 1 June 2021 were systematically searched. From eligible studies, the values of the odds ratio (OR) of EVLW as a risk factor for mortality, and the value of EVLW in survivors and non-survivors were extracted. Pooled OR were calculated from available studies. Mean differences and standard deviation of the EVLW between survivors and non-survivors were calculated. A random effects model was computed on the weighted mean differences across the two groups to estimate the pooled size effect. Subgroup analyses were performed to explore the possible sources of heterogeneity.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>Of the 18 studies included (1296 patients), OR could be extracted from 11 studies including 905 patients (464 survivors vs. 441 non-survivors), and 17 studies reported EVLW values of survivors and non-survivors, including 1246 patients (680 survivors vs. 566 non-survivors). The pooled OR of EVLW for mortality from eleven studies was 1.69 (95% confidence interval (CI) [1.22; 2.34], <jats:italic>p</jats:italic> < 0.0015). EVLW was significantly lower in survivors than non-survivors, with a mean difference of −4.97 mL/kg (95% CI [−6.54; −3.41], <jats:italic>p</jats:italic> < 0.001). The results regarding OR and mean differences were consistent in subgroup analyses.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>The value of EVLW measured by TPTD is associated with mortality in critically ill patients and is significantly higher in non-survivors than in survivors. This finding may also be interpreted as an indirect confirmation of the reliability of TPTD for estimating EVLW at the bedside. Nevertheless, our results should be considered cautiously due to the high risk of bias of many studies included in the meta-analysis and the low rating of certainty of evidence.</jats:p>
<jats:p><jats:italic>Trial registration</jats:italic> the study protocol was prospectively registered on PROSPERO: CRD42019126985.</jats:p>
</jats:sec>
Subjects
respiratory-distress-syndrome
;
predicted body-weight
;
diffuse alveolar damage
;
prognostic value
;
sepsis patients
;
septic shock
;
diagnosis
;
calibrate
;
severity
;
bias
;
critical illness
;
extravascular lung water
;
humans
;
prognosis
;
reproducibility of results
;
thermodilution
;
article
;
confidence interval
;
critically ill patient
;
diagnostic test accuracy study
;
extravascular lung water index
;
hemodynamic monitoring
;
human
;
lung edema
;
meta analysis
;
mortality
;
odds ratio
;
prognosis
;
receiver operating characteristic
;
risk factor
;
survivor
;
systematic review
;
thermodilution
;
critical illness
;
lung extravascular fluid
;
procedures
;
prognosis
;
reproducibility