Utility of inferior vena cava diameter ratio on computed tomography scan among low-risk elderly patients in the emergency department
1Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Yangcheon-gu, 07985 Seoul, Republic of Korea
2Chung Ang University College of Medicine, Dongjak-gu, 06974 Seoul, Republic of Korea
3Department of Emergency Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Gangseo-gu, 07804 Seoul, Republic of Korea
4Department of Radiology, G sam hospital, Gunpo-si, 15839 Gyeonggi-do, Republic of Korea
5Seoul National University, College of Economics, , Gwanak-gu, 08826 Seoul, Republic of Korea
Submitted: 29 June 2021 Accepted: 13 August 2021
Online publish date: 27 September 2021
Hypovolemia is a major risk factor for morbidity and mortality among elderly older patients. The inferior vena cava (IVC) diameter is known to predict the fluid volume status in ill patients. This study aimed to evaluate the predictive performance of the IVC diameter ratio, as determined by computed tomography (CT), for poor outcomes among low risk patients 65 years of age and older. This single-center retrospective study was conducted on patients who taken CT during the clinical process between January 2019 and December 2020. IVC diameter ratio measurement was estimated by dividing the maximum value of the anteroposterior diameter from the maximum value of transverse diameter at the level right above the renal vein. The IVC diameter ratio’s prognostic performance was evaluated by using the area under the receiver operating characteristic (AUROC) curve. The mean IVC diameter ratio was 1.78. Multivariable logistic regression analysis revealed age, pulse rate, aspartate aminotransferase level, and IVC diameter ratio as significant risk factors for in-hospital death. The area under the receiver operating curve for predicting death using the IVC diameter ratio of patients with pulse rates under 95 was 0.701 and the cut-off value was 1.638, with an 88.9% sensitivity and 45.2% specificity. The odds ratio for higher IVC diameter ratio values was statistically significant (p = 0.031) for predicting in-hospital death. IVC measurement using abdomen& pelvic computed tomography (APCT ) demonstrated capability for predicting poor outcomes, including all-cause mortality among older patients with low risk in the emergency department.
Dehydration; Emergency medicine; Geriatric; Inferior vena cava ratio; Computed tomography
Sun Hwa Lee,Sung Jin Bae,Keon Kim,Seong Jong Yun,Jong Seok Oh,Ji Yeon Lim. Utility of inferior vena cava diameter ratio on computed tomography scan among low-risk elderly patients in the emergency department. Signa Vitae. 2021.doi:10.22514/sv.2021.212.
 Wu W, Li DX, Wang Q, Xu Y, Cui YJ. Relationship between high-sensitivity cardiac troponin T and the prognosis of elderly inpatients with non-acute coronary syndromes. Clinical Interventions in Aging. 2018; 13: 1091–1098.
 Gao J, Chen M, Wang X, Wang H, Zhuo L. Risk factors and prognosis of acute kidney injury in adult hospitalized patients: a two-year outcome. Minerva Urology and Nephrology. 2015; 67: 179–185.
 Manabe T, Teramoto S, Tamiya N, Okochi J, Hizawa N. Risk factors for aspiration pneumonia in older adults. PLoS ONE. 2015; 10: e0140060.
 Hu KM, Brown RM. Resuscitation of the Critically Ill Older Adult. Emergency Medicine Clinics of North America. 2021; 39: 273–286.
 Thomas DR, Cote TR, Lawhorne L, Levenson SA, Rubenstein LZ, Smith DA, et al. Understanding Clinical Dehydration and its Treatment. Journal of the American Medical Directors Association. 2008; 9: 292–301.
 Swerdel JN, Janevic TM, Kostis WJ, Faiz A, Cosgrove NM, Kostis JB. Association between Dehydration and Short-Term Risk of Ischemic Stroke in Patients with Atrial Fibrillation. Translational Stroke Research. 2017; 8: 122–130.
 El-Sharkawy AM, Sahota O, Lobo DN. Acute and chronic effects of hydration status on health. Nutrition Reviews. 2015; 73: 97–109.
 Manz F. Hydration and Disease. Journal of the American College of Nutrition. 2007; 26: 535S–541S.
 Johnson JJ, Garwe T, Albrecht RM, Adeseye A, Bishop D, Fails RB, et al. Initial inferior vena cava diameter on computed tomographic scan independently predicts mortality in severely injured trauma patients. Journal of Trauma and Acute Care Surgery. 2013; 74: 741–746.
 Armstrong LE. Assessing Hydration Status: the Elusive Gold Standard. Journal of the American College of Nutrition. 2007; 26: 575S–584S.
 Shirreffs SM. Markers of hydration status. European Journal of Clinical Nutrition. 2003; 57: S6–S9.
 Bhave G, Neilson EG. Volume Depletion Versus Dehydration: how Understanding the Difference can Guide Therapy. American Journal of Kidney Diseases. 2011; 58: 302–309.
 Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. The American Journal of Emergency Medicine. 2012; 30: 1414–1419.e1.
 Beier K, Eppanapally S, Bazick HS, Chang D, Mahadevappa K, Gibbons FK, et al. Elevation of blood urea nitrogen is predictive of long-term mortality in critically ill patients independent of “normal” creatinine. Critical Care Medicine. 2011; 39: 305–313.
 Favot M, Courage C, Mantouffel J, Amponsah D. Ultrasound training in the emergency medicine clerkship. Western Journal of Emergency Medicine. 2015; 16: 938.
 Milia DJ, Dua A, Paul JS, et al. Clinical utility of flat inferior vena cava by axial tomography in severely injured elderly patients. Journal of Trauma and Acute Care Surgery. 2013; 75: 1002–1005.
 Matsumoto S, Sekine K, Yamazaki M, Sasao K, Funabiki T, Shimizu M, et al. Predictive Value of a Flat Inferior Vena Cava on Initial Computed Tomography for Hemodynamic Deterioration in Patients with Blunt Torso Trauma. Journal of Trauma: Injury, Infection & Critical Care. 2010; 69: 1398–1402.
 Wallace DJ, Allison M, Stone MB. Inferior Vena Cava Percentage Collapse during Respiration is Affected by the Sampling Location: an Ultrasound Study in Healthy Volunteers. Academic Emergency Medicine. 2010; 17: 96–99.
 Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian Journal of Internal Medicine. 2013; 4: 627.
 Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics. 1977; 33: 159.
 Albani S, Pinamonti B, Giovinazzo T, de Scordilli M, Fabris E, Stolfo D. Accuracy of right atrial pressure estimation using a multi-parameter approach derived from inferior vena cava semi-automated edge-tracking echocardiography: A pilot study in patients with cardiovascular disorders. The International Journal of Cardiovascular Imaging. 2020; 1–13.
 Magder S. How to use central venous pressure measurements. Current Opinion in Critical Care. 2005; 11: 264–270.
 Jamshidi R. Central venous catheters: Indications, techniques, and complications. Seminars in Pediatric Surgery. 2019; 28: 26–32.
 Michard F, Teboul J. Predicting Fluid Responsiveness in ICU Patients. Chest. 2002; 121: 2000–2008.
 Wagner JG, Leatherman JW. Right Ventricular End-Diastolic Volume as a Predictor of the Hemodynamic Response to a Fluid Challenge. Chest. 1998; 113: 1048–1054.
 Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Critical Care Medicine. 2004; 32: 691–699.
 Arif Khammas A, Mahmud R. Ultrasonographic measurements of the liver, gallbladder wall thickness, inferior vena cava, portal vein and pancreas in an Urban Region, Malaysia. Journal of Medical Ultrasound. 2021; 29: 26.
 Sefidbakht S, Assadsangabi R, Abbasi HR, Nabavizadeh A. Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emergency Radiology. 2007; 14: 181–185.
 Kim H, Kim JH, Kim JS, Hong DY, Han SB, Lee HJ. Acute nontraumatic abdominal pain in elderly patients: impact of abdominal CT evaluation. Journal of the Korean Society of Emergency Medicine. 2005; 16: 640–645.
 Kingwell BA. Large Artery Stiffness: Implications for Exercise Capacity and Cardiovascular Risk. Clinical and Experimental Pharmacology and Physiology. 2002; 29: 214–217.
 Vaitkevicius PV, Fleg JL, Engel JH, O’Connor FC, Wright JG, Lakatta LE, et al. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation. 1993; 88: 1456–1462.
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