Changes in the venous return system and mortality in patients with constrictive pericarditis after pericardial stripping: a retrospective cohort study

Abstract

This study aimed to explore changes in the venous return system in patients with Constrictive pericarditis(CP) after pericardial stripping and examine their value in predicting mortality. An 8-year single-center retrospective cohort study including patients with CP after pericardial stripping surgery in Intensive care unit (ICU), Peking Union Medical College Hospital. Hemodynamic parameters were analyzed in 90 patients at 11 time points including before and after surgery and every 4 to 9 hours in the first 48 hours in the ICU (0h, t1-t3, 24h, t4-t6, 48h). Mean systemic filling pressure (Pmsf) and resistance to venous return (RVr) were significantly higher in patients who died (non-survival group) than survivors (P = 0.016 and 0.022, respectively). There was a negative correlation between Pmsf at 24h and lactate clearance rate at 6h, while the difference in Pmsf − central venous pressure (CVP) between 48h and 0h was positively correlated with both total fluid balance at 48h and serum creatinine at the time of transfer out of the ICU. Pmsf at 0h, Pmsf at 24h, Pmsf − CVP at 0h, RVr before surgery, RVr at 24h, APACHE II score, and SOFA score were evaluated as predictors of 28-day mortality. The area under the receiver operating characteristic curve was largest for RVr before surgery (0.771; 95% confidence interval, 0.583–0.958; P = 0.034). Pmsf at 0h, Pmsf at 24h, Pmsf − CVP at 0h, RVr before surgery, and RVr at 24h, respectively, combined with APACHE II and SOFA were significant predictors of 28-day mortality. SOFA combined with RVr before surgery had the best performance (area under the receiver operating characteristic curve, 0.883; 95% confidence interval, 0.758–1.000; P = 0.003). Conclusions: Pmsf, Pmsf − CVP, and RVr can be used as valid indicators for prognostic assessment in patients with constrictive pericarditis after pericardial stripping.