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Gavelli F, Castello LM, Monnet X, Azzolina D, Nerici I, Priora S, Via VG, Bertoli M, Foieni C, Beltrame M, Bellan M, Sainaghi PP, De Vita N, Patrucco F, Teboul JL, Avanzi GC. Decrease of haemoconcentration reliably detects hydrostatic pulmonary oedema in dyspnoeic patients in the emergency department - a machine learning approach. Int J Emerg Med 2024; 17:114. [PMID: 39237860 PMCID: PMC11375861 DOI: 10.1186/s12245-024-00698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Haemoglobin variation (ΔHb) induced by fluid transfer through the intestitium has been proposed as a useful tool for detecting hydrostatic pulmonary oedema (HPO). However, its use in the emergency department (ED) setting still needs to be determined. METHODS In this observational retrospective monocentric study, ED patients admitted for acute dyspnoea were enrolled. Hb values were recorded both at ED presentation (T0) and after 4 to 8 h (T1). ΔHb between T1 and T0 (ΔHbT1-T0) was calculated as absolute and relative value. Two investigators, unaware of Hb values, defined the cause of dyspnoea as HPO and non-HPO. ΔHbT1-T0 ability to detect HPO was evaluated. A machine learning approach was used to develop a predictive tool for HPO, by considering the ability of ΔHb as covariate, together with baseline patient characteristics. RESULTS Seven-hundred-and-six dyspnoeic patients (203 HPO and 503 non-HPO) were enrolled over 19 months. Hb levels were significantly different between HPO and non-HPO patients both at T0 and T1 (p < 0.001). ΔHbT1-T0 were more pronounced in HPO than non-HPO patients, both as relative (-8.2 [-11.2 to -5.6] vs. 0.6 [-2.1 to 3.3] %) and absolute (-1.0 [-1.4 to -0.8] vs. 0.1 [-0.3 to 0.4] g/dL) values (p < 0.001). A relative ΔHbT1-T0 of -5% detected HPO with an area under the receiver operating characteristic curve (AUROC) of 0.901 [0.896-0.906]. Among the considered models, Gradient Boosting Machine showed excellent predictive ability in identifying HPO patients and was used to create a web-based application. ΔHbT1-T0 was confirmed as the most important covariate for HPO prediction. CONCLUSIONS ΔHbT1-T0 in patients admitted for acute dyspnoea reliably identifies HPO in the ED setting. The machine learning predictive tool may represent a performing and clinically handy tool for confirming HPO.
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Affiliation(s)
- Francesco Gavelli
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy.
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy.
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Hôpitaux universitaires Paris- Saclay, APHP, rue du Général Leclerc, Paris, France.
| | - Luigi Mario Castello
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Xavier Monnet
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Hôpitaux universitaires Paris- Saclay, APHP, rue du Général Leclerc, Paris, France
| | - Danila Azzolina
- Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy
| | - Ilaria Nerici
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Simona Priora
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Valentina Giai Via
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Matteo Bertoli
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Claudia Foieni
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Michela Beltrame
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
| | - Nello De Vita
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
| | - Filippo Patrucco
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
| | - Jean-Louis Teboul
- Service de médecine intensive-réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Hôpitaux universitaires Paris- Saclay, APHP, rue du Général Leclerc, Paris, France
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy
- Emergency Medicine Department, AOU Maggiore della Carità di Novara, C.so Mazzini 18, Novara, 28100, Italy
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Bouaziz M, Bahloul M, Hergafi L, Kallel H, Chaari L, Hamida CB, Chaari A, Chelly H, Rekik N. Factors associated with pulmonary edema in severe scorpion sting patients--a multivariate analysis of 428 cases. Clin Toxicol (Phila) 2006; 44:293-300. [PMID: 16749548 DOI: 10.1080/15563650600584501] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine clinical and routine laboratory factors associated with pulmonary edema secondary to scorpion envenomation. DESIGN AND SETTING Retrospective study covering 13 years (1990-2002) in the medical Intensive Care Unit of a university hospital (Sfax-Tunisia). PATIENTS 428 patients older than 3 years who were admitted to the intensive care unit for scorpion envenomation were included in this study. Patients were stratified into two groups according to the presence or absence of pulmonary edema as assessed by a medical committee. MEASUREMENTS AND RESULTS The mean (+/- SD) age was 17.5 +/- 17.7 years, ranging from 3 to 76 years. The pulmonary edema group included 294 patients (68.7%). A multivariate analysis found the following factors to be correlated with a pulmonary edema: age less than 5 years (p = 0.04), sweating (p = 0.004), agitation (p = 0.01), leukocytes of 25000 cells/mm3 or more (p = 0.02), and a plasma protein concentration of 72 g/L or more (p < 0.0001). In addition, a plasma protein concentration of 72 g/L or more predicted the presence of pulmonary edema with a sensitivity of 78% a specificity of 88%, a positive predictive value of 93%, and negative predictive value of 64%. Almost 84% of patients having a respiratory rate of > or = 30 breaths/minute associated with agitation and sweating were classified in the pulmonary edema group. This clinical association indicates the presence of pulmonary edema with a specificity of 84.3% and a positive predictive value of 87.5%. CONCLUSION In scorpion envenomation patients older than 3 years, the association of a respiratory rate of > or = 30 breaths/minute, agitation, sweating, or the presence of high plasma protein concentrations suggest the presence of pulmonary edema.
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Affiliation(s)
- Mounir Bouaziz
- Service de Réanimation Médicale, CHU Habib Bourguiba Sfax-Tunisie.
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Androne AS, Hryniewicz K, Hudaihed A, Mancini D, Lamanca J, Katz SD. Relation of unrecognized hypervolemia in chronic heart failure to clinical status, hemodynamics, and patient outcomes. Am J Cardiol 2004; 93:1254-9. [PMID: 15135699 DOI: 10.1016/j.amjcard.2004.01.070] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2003] [Revised: 01/23/2004] [Accepted: 01/23/2004] [Indexed: 12/15/2022]
Abstract
Clinically unrecognized intravascular volume overload may contribute to worsening symptoms and disease progression in patients with chronic heart failure (CHF). The present study was undertaken to prospectively compare measured blood volume status (determined by radiolabeled albumin technique) with clinical and hemodynamic characteristics and patient outcomes in 43 nonedematous ambulatory patients with CHF. Blood volume analysis demonstrated that 2 subjects (5%) were hypovolemic (mean deviation from normal values -20 +/- 6%), 13 subjects (30%) were normovolemic (mean deviation from normal values -1 +/- 1%), and 28 subjects (65%) were hypervolemic (mean deviation from normal values +30 +/- 3%). Physical findings of congestion were infrequent and not associated with blood volume status. Increased blood volume was associated with increased pulmonary capillary wedge pressure (p = 0.01) and greatly increased risk of death or urgent cardiac transplantation during a median follow-up of 719 days (1-year event rate 39% vs 0%, p <0.01 by log-rank test). Systolic blood pressure was significantly lower in hypervolemic patients than in those with normovolemia or hypovolemia (107 +/- 2 vs 119 +/- 2 mm Hg, p = 0.008), and hypotension was independently associated with increased risk of hypervolemia in multivariate analysis (odds ratio 2.64 for a 10-mm Hg decrease in systolic blood pressure, 95% confidence interval 1.13 to 6.19, p = 0.025). These findings demonstrate that clinically unrecognized hypervolemia is frequently present in nonedematous patients with CHF and is associated with increased cardiac filling pressures and worse patient outcomes.
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Affiliation(s)
- Ana Silvia Androne
- Department of Internal Medicine, Yale University School of Medicine, 135 College Street, New Haven, CT 06510, USA
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Cotton DB, Strassner HT, Lipson LG, Goldstein DA. The effects of terbutaline on acid base, serum electrolytes, and glucose homeostasis during the management of preterm labor. Am J Obstet Gynecol 1981; 141:617-24. [PMID: 7315890 DOI: 10.1016/s0002-9378(15)33300-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Terbutaline (T) is a beta-adrenergic compound which is commonly employed as a tocolytic agent in preterm labor. We evaluated the metabolic and biophysical consequences of infusion of T into six pregnant women in preterm labor. Our results showed that the infusion of T led to the development of hyperglycemia, hyperinsulinemia, hyperlactacidemia, hypokalemia, a fall in serum colloid osmotic pressure and pH, a rise in maternal heart rate, and a fall in maternal blood pressure. These changes in electrolytes in the serum occurred in the absence of any significant alterations in their urinary excretion. These data suggest that the infusion of T causes hyperglycemia that results in a rise in serum insulin and lactate, which, in turn, leads to a fall in serum potassium, ionized calcium, and pH. Volume expansion as manifested by a fall in colloid osmotic pressure may contribute to the reduction in the levels of ionized and total calcium. Thus, careful monitoring of electrolytes and hydration status is warranted when beta-mimetic agents are used, specifically T, for tocolytic therapy.
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Henning RJ, Becker H, Vincent JL, Thijs L, Kalter E, Weil MH. Use of methylprednisolone in patients following acute myocardial infarction. Hemodynamic and metabolic effects. Chest 1981; 79:186-94. [PMID: 7460650 DOI: 10.1378/chest.79.2.186] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Hemodynamic and metabolic effects of methylprednisolone were investigated in a double-blind study of 28 patients with acute myocardial infarction (AMI), confirmed by unequivocal electrocardiographic and enzyme changes. Measurements were performed prior to and at 1.5, 3, 4, 4.5, 12 and 24 hours following infusion of methylprednisolone (13 patients) or placebo (15 patients). Although systemic vascular resistance decreased from 1,750 to 1,420 dynes . sec . cm-5 (p less than .001) and cardiac index increased from 2.77 to 3.10 L/min/m2 (p less than .02) between 0 and 4.5 hours, an abnormal increase in blood lactate was observed in 10 of the 13 patients following administration of methylprednisolone (3.0 vs 1.2 mM/L, p less than .001). Lactate elevation appeared one hour after infusion of methylprednisolone, was maximal at 12 hours, and persisted for more than 24 hours. There was no significant change in blood lactate in placebo treated patients. A transient but significant decrease in plasma volume was also observed following infusions of methylprednisolone. The elevation of blood lactate could not be explained by the reduction in plasma volume since the most striking increases in lactate were observed 12 hours following the initial infusion of methylprednisolone when the plasma volume was returning to the control value. No significant differences in other hemodynamic or metabolic parameters, infarct size or patient survival were observed between the two groups. We conclude that the hemodynamic benefits of glucocorticoids characterized by increased cardiac output and lowered systemic vascular resistance are counterbalanced by the potentially unfavorable conditions of lactate elevation and volume depletion.
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