Echocardiography-derived pulmonary vascular resistance outperforms coagulation profiles and thromboelastography in predicting in-hospital mortality among surgical intensive care unit patients
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Patients in the surgical intensive care unit (SICU) frequently present with coagulation disorders and cardiopulmonary interaction disturbances. This study aimed to examine alterations in coagulation status and pulmonary vascular resistance (PVR), and compare their predictive efficacy for in-hospital mortality in this population. Methods: In this prospective observational study (January 2025 to April 2025), 61 consecutive SICU patients were enrolled and stratified into survivors (n=43) and non-survivors (n=18). Comprehensive echocardiographic assessments were performed to quantify PVR. Coagulation test and thromboelastography (TEG) were used to monitor coagulation status. Multivariable logistic regression identified independent predictors of in-hospital mortality. Results: 31.00 (24.00-44.00) mmHg, P<0.0001] compared to survivors, alongside significant reductions in cardiac chamber dimensions, systolic function and reduced cardiac output (all P<0.05). Multivariate analysis identified PVR [odds ratio (OR) =284.280; 95% confidence interval (CI): 23.887-3,383.278; P<0.0001], APTT (OR =1.799; 95% CI: 1.367-2.369; P<0.0001), and FDP (OR =1.155; 95% CI: 1.071-1.244; P=0.0002) as independent in-hospital mortality determinants. Receiver operating characteristic (ROC) analysis demonstrated superior predictive performance of PVR [area under the curve (AUC) =0.865; cutoff, 2.175 Wood units; sensitivity, 97.94%; specificity, 73.36%] and the combined model incorporating PVR, APTT, and FDP (AUC =0.978; cutoff, 0.593; sensitivity, 92.59%; specificity, 97.40%) compared to isolated APTT (AUC =0.749; cutoff, 29.500 s; sensitivity, 83.52%; specificity, 71.18%) or FDP measurements (AUC =0.645; cutoff, 26.000 μg/L; sensitivity, 70.21%; specificity, 69.87%) (all pairwise comparisons, P<0.05). Conclusions: Among SICU patients, echocardiography-derived PVR demonstrates superior clinical utility over coagulation tests and TEG in predicting in-hospital mortality among SICU patients, highlighting the prognostic significance of PVR and the combined model incorporating PVR, APTT, and FDP in critical illness outcomes.
Authors: Xuchu Wu, Donghua Wang, Jie Zhang, Xiaozhi Zheng
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7117757182
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