Association Between Early Central Venous Pressure Measurement and Mortality in Patients With Sepsis: A Retrospective Study

Abstract

Background: It remains controversial to abandon central venous pressure (CVP) in the monitoring of fluid resuscitation in sepsis patients. We hypothesized that early CVP measurement was associated with decreased mortality in critically ill patients with sepsis. Methods: Critically ill patients with sepsis were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Patients were divided into two groups base on whether or not they had a CVP measurement within the first 6 hours of ICU stay. The primary endpoint was 28-day mortality. Patients were further divided into four subgroups base on the time when the first CVP measurement was obtained: within 3 hours, between 3 and 6 hours, between 6 and 12 hours, and not measured within 12 hours. Kaplan-Meier survival analysis and Cox regression model were used for univariate and multivariate analyses of survival, respectively.RESULTS: A total of 4733 sepsis patients were included. The 28-day mortality was significantly lower in the CVP measured group than in the control group (34.2 vs. 40.7, p < 0.001). A “U”-shaped relationship between initial CVP and mortality was identified. With patients without CVP measured within 12 hours serving as the reference subgroup, timely CVP measurement was associated with decreased 28-day mortality before and after adjusting for confounding variables.CONCLUSIONS: Early CVP measurement is associated with decreased 28-day mortality in patients with sepsis. CVP should be considered as a valuable and easily accessible safety parameter during (early) fluid resuscitation.

Value of Central Venous Pressure Monitoring in the Patients with Sepsis-Associated Acute Kidney Injury

“…We also explored the association between the observational time points of CVP measurement and outcomes which shows early CVP measurement is associated with decreased ICU length of stay and hospital length of stay (6.2 and 10.9, respectively, P < 0:05). This view is supported by previous studies showing that the 28-day mortality in the early CVP measurement group was signifi-cantly lower than that in the control group (34.2% vs. 40.7%, P < 0:01) [26]. Some patients in our study had their first CVP measurement within 13 to 24 hours of admission, and their CVP levels, fluid load, and MPP were higher than those of other groups (median 19.0 mmHg, 4.8 mL/kg, and 93 mmHg, respectively).…”