Diagnostic determinants for capillary leakage syndrome (CLS) in septic shock patients

Objectives

CLS is a frequent complication in sepsis characterized by loss of intravasal fluids leading to generalized edema and hypotension. Despite the importance there are still no standardized diagnostic criteria available for CLS. The aim of this study was to evaluate diagnostic determinants for CLS.

Design

Prospective clinical study.

Methods

The study was performed in 4 patients with septic shock (SOFA-Score = 12 ± 2), multiple organ failure and CLS compared to 4 control patients. CLS was judged clinically by generalized edema, positive fluid balance and weight gain. Plasma volume by indocyanin green (PV_ICG), red blood cell volume by tagged chromium-51 (RBC:⁵¹Cr), extracellular fluid volume (ECF) calculated by inulin space technique and colloid osmotic pressure (COP) were measured before (T0 = 0 min) and after (T1 = 90 min) administration of 300 ml of albumin 20%. Measurement of total body water (TBV) and the phase angle (phi, degrees), a global parameter of the body composition were performed using bioelectrical impedance analysis (BIA).

Results

PV_ICG was measured in CLS patients with 45.9 ± 14.6 ml/kg/ total body weight (BW) and in controls with 67.8 ± 15.2 ml/kg/BW. The RBC:⁵¹Cr averaged 20.2 ± 1.3 ml/kg/BW in CLS patients and in the controls 24.4 ± 3.7 ml/kg/BW. ECF was expanded in CLS patients compared to controls (45.1 ± 8.5%BW vs. 29.5 ± 6.7%BW; P < 0.05). Increase of COP level at T2 in CLS patients was smaller than in the control patients (1.1 ± 0.4 mmHg vs. 2.4 ± 1.0 mmHg; P < 0.05). Phi was low in CLS patients (2.1 ± 0.8° vs. 4.8 ± 1.2°; P < 0.05) and TBV was elevated compared to controls (76.5 ± 12.0 kg vs. 55.7 ± 3.8 kg; P < 0.05).

Conclusion

These results suggest that measurements of phi and TBV using BIA combined with a difference of COP levels before and after administration of albumin are promising approaches to discriminate CLS from non-CLS patients at the bed-side.