Utility of Inferior Vena Cava Diameter Ratio as a Prognostic Factor in Sepsis or Septic Shock Patients with Abdomen Computed Tomography

Ju, Jin Su; Kim, Yang Weon; Kang, Ji Hun; Yoon, Yoo Sang

J Korean Soc Emerg Med > Volume 28(4); 2017 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2017;28(4): 318-326.

복부 전산화 단층 촬영을 시행한 패혈증과 패혈성 쇼크 환자의 예후 예측 인자로서 하대정맥 직경비의 유용성

주진수¹, 김양원¹, 강지훈¹, 윤유상^1,2

¹인제대학교 의과대학 응급의학교실
²인제대학교 인문의학연구소

Utility of Inferior Vena Cava Diameter Ratio as a Prognostic Factor in Sepsis or Septic Shock Patients with Abdomen Computed Tomography

Jin Su Ju¹, Yang Weon Kim¹, Ji Hun Kang¹, Yoo Sang Yoon^1,2

¹Department of Emergency Medicine, Inje University College of Medicine, Busan, Korea
²The Institute for Medical Humanities, Inje University, Busan, Korea

Correspondence

Yoo Sang Yoon ,Tel: 051-890-6120, Fax: 051-891-1465, Email: 101mars@hanmail.net,

Received: May 30, 2017; Revised: June 1, 2017 Accepted: July 19, 2017. Published online: August 31, 2017.

ABSTRACT

Purpose:
This study measured the availability of the ‘inferior vena cava (IVC) diameter ratio’ in sepsis or septic shock patients using computed tomography (CT) to determine if it can be used as a predictive factor for the 28-day mortality.
Method:
This retrospective analysis included patients between March 2016 and February 2017. One hundred fortyeight sepsis patients and 62 septic shock patients were included. The patients were divided into 2 groups (28-day survivors and non-survivors). The IVC diameter ratio (maximal transverse-to-maximal anteroposterior diameter immediately below the level of the renal vein) was measured by abdominal CT in the axial view. Using SPSS Statistics ver. 20.0, the IVC diameter ratio was analyzed by logistic regression analysis to identify the predictors of the 28-day mortality. Receiver operating characteristics (ROC) curves were used to determine the cut-off value for the maximum sensitivity and specificity for an evaluation of the availability as a predictive factor (28-day mortality).
Results:
In the sepsis group, 38 out of 148 patients (25.7%) died. In the septic shock group, 29 out of 62 patients (46.8%) died. The IVC diameter ratio was significantly higher in the non-survivors than the survivors in both the sepsis and septic shock groups. In the sepsis patients, the odds ratio was 8.95. The area under the ROC curve (AUC) of the IVC diameter ratio for the 28-day survival was 0.817; the cut-off value was 1.60:1. The sensitivity and specificity was 73.7% and 75.5%, respectively. The positive and negative predictive value was 50.9% and 89.2%, respectively. In the septic shock patients, the odds ratio was 39.99. The AUC of the IVC diameter ratio for the 28-day survival was 0.831; the cut-off value, sensitivity, and specificity was 1.90:1, 75.9%, and 81.8%, respectively. The positive and negative predictive values were 78.6% and 79.4% respectively.
Conclusion:
The IVC diameter ratio (maximal transverse-to-maximal anteroposterior diameter) is associated with the 28- day mortality in sepsis or septic shock patients who have undergone abdomen CT.

Key words: Sepsis, Mortality, Vena cava, Inferior