AIM To analyze the changes of global end-diastolic volume index (GEDI) and extravascular lung water index (ELWI) in elderly patients with heart failure (HF) combined with septic shock, explore their prognostic value and provide relevant evidence for clinical early prediction of prognosis and adjustment of treatment regimens.
METHODS From January 2017 to May 2020, 87 elderly patients with HF and septic shock in our hospital were selected and divided into survival group (66 cases) and death group (21 cases) according to their survival status during hospitalization. The general data, GEDI, ELWI, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE II) scores and Sequential Organ Failure Assessment (SOFA) scores before and after fluid resuscitation were compared between the two groups. Perason correlation was used to analyze the correlation between GEDI, ELWI and APACHE Ⅱ scores, SOFA scores. Logistic regression analysis was used to analyze the prognostic factors of elderly patients with HF and septic shock. The receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of GEDI and ELWI.
RESULTS There were statistically significant differences in age, cardiac function classification and ARDS between the two groups (P<0.05). APACHE Ⅱ scores, SOFA scores and ELWI in survival group were lower than those before fluid resuscitation at 6h and 24h after fluid resuscitation, and were lower than those in death group, and GEDI was higher than that before fluid resuscitation and was higher than that in death group (P<0.05). Pearson correlation analysis showed that GEDI at 6h and 24h after fluid resuscitation was negatively correlated with APACHE II and SOFA scores, and at 6h and 24h after fluid resuscitation, ELWI was positively correlated with APACHE II and SOFA scores (P<0.05). Logistic regression analysis showed that age, cardiac function classification, combined ARDS, GEDI and ELWI at 6h and 24h after fluid resuscitation were important factors affecting the prognosis of elderly patients with HF and septic shock (P<0.05). ROC curve analysis showed that at 6h and 24h after fluid resuscitation, the AUC of prognosis predicted by GEDI and ELWI was 0.853 (95% CI 0.761～0.920) and 0.885 (0.798～0.943), the sensitivity was 71% and 81%, and the specificity was 82% and 86%, which were better than the prediction by either of them alone at the same time point (P<0.05).
CONCLUSION GEDI and ELWI can be used as sensitive factors to assess changes of patients’ condition and to predict the prognosis of elderly patients with HF and septic shock.
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