Cargando…
The use of venous Doppler to predict adverse kidney events in a general ICU cohort
BACKGROUND: Changes in Doppler flow patterns of hepatic veins (HV), portal vein (PV) and intra-renal veins (RV) reflect right atrial pressure and venous congestion; the feasibility of obtaining these assessments and the clinical relevance of the findings is unknown in a general ICU population. This...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574322/ https://www.ncbi.nlm.nih.gov/pubmed/33076961 http://dx.doi.org/10.1186/s13054-020-03330-6 |
_version_ | 1783597617703288832 |
---|---|
author | Spiegel, Rory Teeter, William Sullivan, Scott Tupchong, Keegan Mohammed, Nabeel Sutherland, Mark Leibner, Evan Rola, Philippe Galvagno, Samuel M. Murthi, Sarah B. |
author_facet | Spiegel, Rory Teeter, William Sullivan, Scott Tupchong, Keegan Mohammed, Nabeel Sutherland, Mark Leibner, Evan Rola, Philippe Galvagno, Samuel M. Murthi, Sarah B. |
author_sort | Spiegel, Rory |
collection | PubMed |
description | BACKGROUND: Changes in Doppler flow patterns of hepatic veins (HV), portal vein (PV) and intra-renal veins (RV) reflect right atrial pressure and venous congestion; the feasibility of obtaining these assessments and the clinical relevance of the findings is unknown in a general ICU population. This study compares the morphology of HV, PV and RV waveform abnormalities in prediction of major adverse kidney events at 30 days (MAKE30) in critically ill patients. STUDY DESIGN AND METHODS: We conducted a prospective observational study enrolling adult patients within 24 h of admission to the ICU. Patients underwent an ultrasound evaluation of the HV, PV and RV. We compared the rate of MAKE-30 events in patients with and without venous flow abnormalities in the hepatic, portal and intra-renal veins. The HV was considered abnormal if S to D wave reversal was present. The PV was considered abnormal if the portal pulsatility index (PPI) was greater than 30%. We also examined PPI as a continuous variable to assess whether small changes in portal vein flow was a clinically important marker of venous congestion. RESULTS: From January 2019 to June 2019, we enrolled 114 patients. HV abnormalities demonstrate an odds ratio of 4.0 (95% CI 1.4–11.2). PV as a dichotomous outcome is associated with an increased odds ratio of MAKE-30 but fails to reach statistical significance (OR 2.3 95% CI 0.87–5.96), but when examined as a continuous variable it demonstrates an odds ratio of 1.03 (95% CI 1.00–1.06). RV Doppler flow abnormalities are not associated with an increase in the rate of MAKE-30 INTERPRETATION: Obtaining hepatic, portal and renal venous Doppler assessments in critically ill ICU patients are feasible. Abnormalities in hepatic and portal venous Doppler are associated with an increase in MAKE-30. Further research is needed to determine if venous Doppler assessments can be useful measures in assessing right-sided venous congestion in critically ill patients. |
format | Online Article Text |
id | pubmed-7574322 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-75743222020-10-20 The use of venous Doppler to predict adverse kidney events in a general ICU cohort Spiegel, Rory Teeter, William Sullivan, Scott Tupchong, Keegan Mohammed, Nabeel Sutherland, Mark Leibner, Evan Rola, Philippe Galvagno, Samuel M. Murthi, Sarah B. Crit Care Research BACKGROUND: Changes in Doppler flow patterns of hepatic veins (HV), portal vein (PV) and intra-renal veins (RV) reflect right atrial pressure and venous congestion; the feasibility of obtaining these assessments and the clinical relevance of the findings is unknown in a general ICU population. This study compares the morphology of HV, PV and RV waveform abnormalities in prediction of major adverse kidney events at 30 days (MAKE30) in critically ill patients. STUDY DESIGN AND METHODS: We conducted a prospective observational study enrolling adult patients within 24 h of admission to the ICU. Patients underwent an ultrasound evaluation of the HV, PV and RV. We compared the rate of MAKE-30 events in patients with and without venous flow abnormalities in the hepatic, portal and intra-renal veins. The HV was considered abnormal if S to D wave reversal was present. The PV was considered abnormal if the portal pulsatility index (PPI) was greater than 30%. We also examined PPI as a continuous variable to assess whether small changes in portal vein flow was a clinically important marker of venous congestion. RESULTS: From January 2019 to June 2019, we enrolled 114 patients. HV abnormalities demonstrate an odds ratio of 4.0 (95% CI 1.4–11.2). PV as a dichotomous outcome is associated with an increased odds ratio of MAKE-30 but fails to reach statistical significance (OR 2.3 95% CI 0.87–5.96), but when examined as a continuous variable it demonstrates an odds ratio of 1.03 (95% CI 1.00–1.06). RV Doppler flow abnormalities are not associated with an increase in the rate of MAKE-30 INTERPRETATION: Obtaining hepatic, portal and renal venous Doppler assessments in critically ill ICU patients are feasible. Abnormalities in hepatic and portal venous Doppler are associated with an increase in MAKE-30. Further research is needed to determine if venous Doppler assessments can be useful measures in assessing right-sided venous congestion in critically ill patients. BioMed Central 2020-10-19 /pmc/articles/PMC7574322/ /pubmed/33076961 http://dx.doi.org/10.1186/s13054-020-03330-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Spiegel, Rory Teeter, William Sullivan, Scott Tupchong, Keegan Mohammed, Nabeel Sutherland, Mark Leibner, Evan Rola, Philippe Galvagno, Samuel M. Murthi, Sarah B. The use of venous Doppler to predict adverse kidney events in a general ICU cohort |
title | The use of venous Doppler to predict adverse kidney events in a general ICU cohort |
title_full | The use of venous Doppler to predict adverse kidney events in a general ICU cohort |
title_fullStr | The use of venous Doppler to predict adverse kidney events in a general ICU cohort |
title_full_unstemmed | The use of venous Doppler to predict adverse kidney events in a general ICU cohort |
title_short | The use of venous Doppler to predict adverse kidney events in a general ICU cohort |
title_sort | use of venous doppler to predict adverse kidney events in a general icu cohort |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574322/ https://www.ncbi.nlm.nih.gov/pubmed/33076961 http://dx.doi.org/10.1186/s13054-020-03330-6 |
work_keys_str_mv | AT spiegelrory theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT teeterwilliam theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT sullivanscott theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT tupchongkeegan theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT mohammednabeel theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT sutherlandmark theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT leibnerevan theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT rolaphilippe theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT galvagnosamuelm theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT murthisarahb theuseofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT spiegelrory useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT teeterwilliam useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT sullivanscott useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT tupchongkeegan useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT mohammednabeel useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT sutherlandmark useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT leibnerevan useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT rolaphilippe useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT galvagnosamuelm useofvenousdopplertopredictadversekidneyeventsinageneralicucohort AT murthisarahb useofvenousdopplertopredictadversekidneyeventsinageneralicucohort |