Haiyan Chen, Buyun Wu, Dehua Gong, Zhihong Liu Critical Care 2015, 19:135 (2 April 2015)
Introduction: It is unclear whether the fluid status, as determined by bioimpedance vector analysis (BIVA) combined with serum N-terminal pro-B-type natriuretic peptides (NT-pro-BNP) measurement, is associated with treatment outcome among patients receiving continuous renal replacement therapy (CRRT). Our objective was to answer it.
Methods: Patients in the intensive care units of an university teaching hospital requiring CRRT were screened for enrollment. For the enrolled patients, BIVA and serum NT-pro BNP measurement were performed just before the start of CRRT and 3 days afterward. According to the BIVA and NT-pro BNP measurement results, the patients were divided into four groups according to fluid status type: type 1, both normal; type 2, normal BIVA results and abnormal NT-pro BNP levels; type 3, abnormal BIVA results and normal NT-pro BNP levels; type 4, both abnormal. The associations between fluid status and outcome were analyzed.
Results: Eighty-nine patients were enrolled, with 58 males and a mean age of 49.0 ± 17.2 years. The mean score of acute physiology and chronic health evaluation II (APACHE II) was 18.8 ± 8.6. The fluid status before CRRT start was as follows: type 1, 21.3% (19/89); type 2, 16.9% (15/89); type 3, 11.2% (10/89); and type 4, 50.6% (45/89). There were significant differences between fluid status types before starting CRRT on baseline values for APACHE II scores, serum creatinine, hemoglobin, platelet count, urine volume, as well as incidences of oliguria and acute kidney injury (p < 0.05). There were significant differences between patients with different fluid status before CRRT start on hospital mortality: type 1, 26.3% (5/19); type 2, 33.3% (5/15); type 3, 40% (4/10); and type 4, 64.4% (29/45) (p = 0.019); as well as renal function recovery rates: type 1, 57.1% (4/7); type 2, 67.7% (6/9); type 3, 50% (3/6); and type 4, 23.7% (9/38) (p = 0.051).
Conclusions: Fluid status abnormalities were common among patients receiving CRRT. Different types of fluid status distinguished by BIVA combined with serum NT-pro BNP measurements corresponded to different clinical conditions and treatment outcomes, which implies a value of this method for evaluation of fluid status among patients receiving CRRT.
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