Effective Arterial Elastance as The Best Predictor of Mean Arterial Pressure in Patients with Sepsis or Septic Shock Receiving Fluid Expansion: A Validation Study by Regression Analysis

Abstract

Abstract Backgroundwe conducted this study to compare four arterial load parameters and determine which arterial load parameters directly impacted arterial pressure regarding pressure, flow, and arterial system relationship.MethodsWe conducted a cross-sectional study in patients with sepsis who underwent volume expansion (VE). Hemodynamic parameters were recorded before and after VE. The relationship between the change of mean arterial pressure (%MAP) and that of the dynamic arterial elastance (EaDyn), effective arterial elastance (Eaeff), net arterial elastance (EaNet), and net arterial resistance (RaNet) was analyzed.ResultsSixty-two patients were included. The DEaDyn(%) was not correlated with DMAP(%) (r=0.048, P=0.826). Meanwhile, DEaeff(%), DEaNet(%), and DRaNet(%) were correlated with DMAP(%) (r=0.495, P&lt;0.001; r=0.453, P&lt;0.001; and r=0.485, P&lt;0.001, respectively). A multiple linear regression model was analyzed for identifying predictors of DMAP(%) by including DCO(%) and each %change of arterial parameters. The best-fit model was found by including DCO(%) and DEaeff(%) in the regression equation (R2=0.823, adjusted R2=0.817). The model was adjusted by age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, arterial lactate level, norepinephrine dosage, ventilator setting, method of VE, and fluid responsiveness and found that DCO(%) and DEaeff(%) remained statistically significant predictors of DMAP(%) (P&lt;0.001 and P&lt;0.001, respectively).ConclusionThe Eaeff was the best AL parameter that correlated with the changes in MAP. Furthermore, the model that included the ∆Eaeff(%) provided the best predictive performance for ∆MAP(%) induced by VE, independent of the fluid responsiveness and norepinephrine dosage.</jats:p