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Diagnosing capillary leak in critically ill patients: development of an innovative scoring instrument for non-invasive detection

Annals of intensive care, 2021-12, Vol.11 (1), p.175-175, Article 175 [Peer Reviewed Journal]

The Author(s) 2021 ;2021. The Author(s). ;COPYRIGHT 2021 Springer ;The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;ISSN: 2110-5820 ;EISSN: 2110-5820 ;DOI: 10.1186/s13613-021-00965-8 ;PMID: 34910264

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  • Title:
    Diagnosing capillary leak in critically ill patients: development of an innovative scoring instrument for non-invasive detection
  • Author: Wollborn, Jakob ; Hassenzahl, Lars O. ; Reker, Daniel ; Staehle, Hans Felix ; Omlor, Anne Marie ; Baar, Wolfgang ; Kaufmann, Kai B. ; Ulbrich, Felix ; Wunder, Christian ; Utzolino, Stefan ; Buerkle, Hartmut ; Kalbhenn, Johannes ; Heinrich, Sebastian ; Goebel, Ulrich
  • Subjects: Anesthesiology ; Biomarkers ; Blood protein disorders ; Capillary leak syndrome ; Critical care ; Critical Care Medicine ; Critically ill ; Diagnosis ; Diagnosis, Noninvasive ; Edema ; Emergency Medicine ; Endothelial permeability ; Fluid balance ; Intensive ; Intensive care ; Medical diagnosis ; Medical examination ; Medicine ; Medicine & Public Health ; Methods ; Sepsis ; Vein & artery diseases
  • Is Part Of: Annals of intensive care, 2021-12, Vol.11 (1), p.175-175, Article 175
  • Description: Background The concomitant occurrence of the symptoms intravascular hypovolemia, peripheral edema and hemodynamic instability is typically named Capillary Leak Syndrome (CLS) and often occurs in surgical critical ill patients. However, neither a unitary definition nor standardized diagnostic criteria exist so far. We aimed to investigate common characteristics of this phenomenon with a subsequent scoring system, determining whether CLS contributes to mortality. Methods We conducted this single-center, observational, multidisciplinary, prospective trial in two separately run surgical ICUs of a tertiary academic medical center. 200 surgical patients admitted to the ICU and 30 healthy volunteers were included. Patients were clinically diagnosed as CLS or No-CLS group (each N = 100) according to the grade of edema, intravascular hypovolemia, hemodynamic instability, and positive fluid balance by two independent attending physicians with > 10 years of experience in ICU. We performed daily measurements with non-invasive body impedance electrical analysis, ultrasound and analysis of serum biomarkers to generate objective diagnostic criteria. Receiver operating characteristics were used, while we developed machine learning models to increase diagnostic specifications for our scoring model. Results The 30-day mortility was increased among CLS patients (12 vs. 1%, P  = 0.002), while showing higher SOFA-scores. Extracellular water was increased in patients with CLS with higher echogenicity of subcutaneous tissue [29(24–31) vs. 19(16–21), P  < 0.001]. Biomarkers showed characteristic alterations, especially with an increased angiopoietin-2 concentration in CLS [9.9(6.2–17.3) vs. 3.7(2.6–5.6)ng/mL, P  < 0.001]. We developed a score using seven parameters (echogenicity, SOFA-score, angiopoietin-2, syndecan-1, ICAM-1, lactate and interleukin-6). A Random Forest prediction model boosted its diagnostic characteristics (AUC 0.963, P  < 0.001), while a two-parameter decision tree model showed good specifications (AUC 0.865). Conclusions Diagnosis of CLS in critically ill patients is feasible by objective, non-invasive parameters using the CLS-Score . A simplified two-parameter diagnostic approach can enhance clinical utility. CLS contributes to mortality and should, therefore, classified as an independent entity. Trial Registration : German Clinical Trials Registry (DRKS No. 00012713), Date of registration 10/05/2017, www.drks.de Graphical Abstract
  • Publisher: Cham: Springer International Publishing
  • Language: English
  • Identifier: ISSN: 2110-5820
    EISSN: 2110-5820
    DOI: 10.1186/s13613-021-00965-8
    PMID: 34910264
  • Source: Directory of Open Access Journals (DOAJ)
    Open Access: PubMed Central
    SpringerOpen
    Geneva Foundation Free Medical Journals at publisher websites
    AUTh Library subscriptions: ProQuest Central
    ROAD
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