Determining the aetiology of pulmonary oedema by the oedema fluid-to-plasma protein ratio.

Ware LB, Fremont RD, Bastarache JA, Calfee CS, Matthay MA
Eur Respir J. 2010 35 (2): 331-7

PMID: 19741024 · PMCID: PMC2819058 · DOI:10.1183/09031936.00098709

We hypothesised that the oedema fluid-to-plasma protein (EF/PL) ratio, a noninvasive measure of alveolar capillary membrane permeability, can accurately determine the aetiology of acute pulmonary oedema. 390 mechanically ventilated patients with acute pulmonary oedema were enrolled. A clinical diagnosis of acute lung injury (ALI), cardiogenic pulmonary oedema or a mixed aetiology was based on expert medical record review at the end of hospitalisation. The EF/PL ratio was measured from pulmonary oedema fluid and plasma samples collected at intubation. 209 patients had a clinical diagnosis of ALI, 147 had a diagnosis of cardiogenic pulmonary oedema and 34 had a mixed aetiology. The EF/PL ratio had an area under the receiver-operating curve of 0.84 for differentiating ALI from cardiogenic pulmonary oedema. Using a predefined cut-off of 0.65, the EF/PL ratio had a sensitivity of 81% and a specificity of 81% for the diagnosis of ALI. An EF/PL ratio >/=0.65 was also associated with significantly higher mortality and fewer ventilator-free days. Noninvasive measurement of the EF/PL ratio is a safe and reliable bedside method for rapidly determining the aetiology of acute pulmonary oedema that can be used at the bedside in both developed and developing countries.

MeSH Terms (14)

Adult Aged Blood Proteins Cohort Studies Female Humans Male Middle Aged Oxygen Permeability Pulmonary Alveoli Pulmonary Edema Respiratory Distress Syndrome, Adult ROC Curve

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