A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation

Purpose Sepsis is a leading cause of morbidity and mortality worldwide and is characterized by vascular leak syndrome. Treatment for sepsis, specifically intravenous fluids, may worsen deterioration in the context of vascular leak. Methods We performed a retrospective cohort study of sepsis patients in four ICU databases in North America, Europe, and Asia. We developed an intuitive vascular leak index (VLI) and determined the relationship between VLI and in-hospital death and 36h-84h fluid balance using generalized additive models (GAM). Results Using GAM, we found that increased VLI is associated with an increased risk of in-hospital death. Patients with a VLI in the highest quartile (Q4), across the four datasets, had a 1.61-2.31 times increased odds of dying in the hospital compared to patients with a VLI in the lowest quartile (Q1). VLI Q2 and Q3 were also associated with increased odds of dying. The relationship between VLI, treated as a continuous variable, and in-hospital death and 36h-84h death was statistically significant in the three datasets with a large number of patients. Specifically, we observed that as VLI increased, there was increase in the risk for in-hospital death and 36h-84h fluid balance. For the few patients with a positive VLI, this relationship differed across databases. Conclusions Our VLI identifies groups of patients who may be at higher risk for in-hospital death and for fluid accumulation early in the ICU course. This relationship persisted in models developed to control for severity of illness and chronic comorbidity burden.