Introduction: Cardiac index is a hemodynamic parameter defined as the ratio of the cardiac output, i.e., the volume of blood ejected from the left ventricle in 1 min, to the body surface area. This study aimed to assess the cardiac index to predict early and 30-day outcomes of non-cardiac patients being admitted to intensive care units using a non-invasive approach.
Materials and Methods: This prospective cohort study included 31 non-cardiac patients who were consecutively admitted to the intensive care units of Rasoul-e-Akram Hospital, Tehran, Iran, in 2016. On admission, the simplified acute physiology score II to predict mortality and the cardiac output (by two-dimensional echocardiography) of each patient were determined. The cardiac index was calculated by dividing the cardiac output by the body surface area. In-hospital mortality and complications were assessed, and the association between simplified acute physiology score II and cardiac index was determined. The patients were followed-up 30 days after discharge by telephone to determine late death, occurrence of myocardial infarction, readmission, or re-hospitalization.
Results: The mean cardiac index was significantly lower among the patients who died in intensive care units than in those who survived (2.86 ± 0.63 versus 3.70 ± 0.49, p = 0.006). A significant inverse association was found between Simplified Acute Physiology Score II and cardiac index (r = −0.539, p = 0.002). The length of hospital and intensive care units stay was not associated with Simplified Acute Physiology Score -II or cardiac index. The receiver operating characteristic curve analysis revealed that the cardiac index was effective in predicting in intensive care units mortality (area under curve = 0.857, p = 0.007). The best cut-off value for the cardiac index to predict in intensive care units mortality was 3.35, yielding a sensitivity of 83.3% and a specificity of 80.0%.
Conclusion: Measuring the cardiac index during intensive care units admission using a noninvasive approach even in non-cardiac patients can predict in intensive care units mortality with high sensitivity and specificity.
Maj G, Monaco F, Landoni G, Barile L, Nicolotti D, Pieri M, Melisurgo G, Pappalardo F, Zangrillo A. Cardiac index assessment by the pressure recording analytic method in unstable patients with atrial fibrillation. Journal of cardiothoracic and vascular anesthesia. 2011 Jun 1;25 (3):476-80.
Zangrillo A, Maj G, Monaco F, Scandroglio AM, Nuzzi M, Plumari V, Virzo I, Bignami E, Casiraghi G, Landoni G. Cardiac index validation using the pressure recording analytic method in unstable patients. Journal of cardiothoracic and vascular anesthesia. 2010 Apr 1;24(2):265-9.
Tibby SM, Murdoch IA. Monitoring cardiac function in intensive care. Archives of disease in childhood. 2003 Jan 1;88(1):46-52.
Van der Does Y, Van Loon LM, Alsma J, Govers A, Lansdorp B, Rood PP, Schuit SC. Non-invasive blood pressure and cardiac index measurements using the Finapres Portapres in an emergency department triage setting. The American journal of emergency medicine. 2013 Jul 1;31(7):1012-6.
Lavdaniti M. Invasive and non-invasive methods for cardiac output measurement. International Journal of Caring Sciences. 2008 Sep 1;1(3):112.
Salehi M, Latif M, Peighambari F, Dehestani M, Ahmadi-Hanzaei SV. Correlation Between Body Mass Index and Echocardiographic Findings in Overweight Patients Compared to Normal-Weight Patients. Internal Medicine and Medical Investigation Journal. 2017 Sep 11;2(3):102-5.
Latif M, Salehi M, Janfada N, Foroutan L, Ashrafi M. Association Between Intraventricular Conduction Disorders and Intrahospital Prognosis in Patients with Acute Coronary Syndrome. Internal Medicine and Medical Investigation Journal. 2018 Jan 8;3(1):32-5.
Mathews L, Singh KR. Cardiac output monitoring. Annals of cardiac anaesthesia. 2008 Jan 1;11(1):56.
Kelley KW, Curtis SE, Marzan GT, Karara HM, Anderson CR. Body surface area of female swine. Journal of animal science. 1973 May 1;36(5):927-30.
Fincke R, Hochman JS, Lowe AM, Menon V, Slater JN, Webb JG, LeJemtel TH, Cotter G, Shock Investigators. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. Journal of the American College of Cardiology. 2004 Jul 21;44(2):340-8.
Soussi S, Deniau B, Ferry A, Levé C, Benyamina M, Maurel V, Chaussard M, Le Cam B, Blet A, Mimoun M, Lambert J. Low cardiac index and stroke volume on admission are associated with poor outcome in critically ill burn patients: a retrospective cohort study. Annals of intensive care. 2016 Dec 1;6(1):87.
Kimmoun A, Ducrocq N, Mory S, Delfosse R, Muller L, Perez P, et al. Cardiac contractile reserve parameters are related to prognosis in septic shock. Biomed Res Int. 2013; 2013:930673.
Eiferman DS, Davido HT, Howard JM, Gerckens J, Evans DC, Cook CH, et al. Two Methods of Hemodynamic and Volume Status Assessment in Critically Ill Patients: A Study of Disagreement. J Intensive Care Med. 2016; 31(2):113-7.
Spotnitz HM, Cabreriza SE, Wang DY, Quinn TA, Cheng B, Bedrosian LN, et al. Primary endpoints of the biventricular pacing after cardiac surgery trial. Ann Thorac Surg. 2013; 96:808-15.
Davari H, Rahim MB, Ershadi R, Rafieian S, Mardani P, Vakili MR, Shirinzadeh A. First Iranian Experience of the Minimally Invasive Nuss Procedure for Pectus Excavatum Repair: A Case Series and Literature Review. Iranian Journal of Medical Sciences. 2017 Dec 2.
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