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Accuracy of the caval index and the expiratory diameter of the inferior vena cava for the diagnosis of dehydration in elderly.
J Ultrasound. 2016 Sep; 19(3):203-9.JU

Abstract

PURPOSE

Dehydration is a very common condition among elderly people. Till date there is not yet a fast and easy method to determine a state of dehydration in the emergency department. In the literature there are some exploratory studies that have tried to establish the relationship between some widely used laboratory values and ultrasound for the purpose of diagnosing dehydration. The primary aim of this study is to verify the correlation between two measures derived by ultrasound (caval index and expiratory diameter of inferior vena cava) and blood urea nitrogen (BUN)/creatinine ratio. The relationship between vital signs and BUN/creatinine ratio has also been explored.

METHODS

An observational cohort study of patients aged 70 years or more, all examined in our ED. The population was divided on the basis of the BUN/creatinine ratio greater or lower than 20.

RESULTS

A total of 270 patients have been considered. No vital sign correlated with an increased BUN/creatinine ratio. Both the diameter of the inferior vena cava in expiratory and the percentage of its collapsibility in inspiratory (caval index) have revealed a correlation with a BUN/creatinine ratio greater than 20. Areas under the curve are, respectively, 76 % (95 % CI 70-82) and 80 % (95 % CI 75-86). Sensitivity, specificity, positive predictive value and negative predictive value are, respectively, 85.5 % (95 % CI 79.4-90.4); 100 % (95 % CI 97-100); 100 % (95 % CI 97.5-100); 82.9 % (95 % CI 75.9-88.7) and 99.3 % (95 % CI 96.3-99.9); 100 % (95 % CI 97-100); 100 % (95 % CI 97.5-100); 99.2 % (95 % CI 95.6-99.9).

CONCLUSIONS

Ultrasound has proved to be useful to diagnose dehydration in elderly people while in the emergency department. Vice versa the vital signs have shown to be unrelated to the hydration state of elderly patients.

Authors+Show Affiliations

Emergency and Critical Care Medicine Division, Department of Medicine, Ospedale Civile di Latisana, A.A.S. 2 "Bassa Friulana-Isontina", via Sabbionera 45, 33053 Latisana, UD Italy.Emergency and Critical Care Medicine Division, Department of Medicine, Ospedale Civile di Latisana, A.A.S. 2 "Bassa Friulana-Isontina", via Sabbionera 45, 33053 Latisana, UD Italy.Emergency and Critical Care Medicine Division, Department of Medicine, Ospedale Civile di Latisana, A.A.S. 2 "Bassa Friulana-Isontina", via Sabbionera 45, 33053 Latisana, UD Italy.Emergency and Critical Care Medicine Division, Department of Medicine, Ospedale Civile di Latisana, A.A.S. 2 "Bassa Friulana-Isontina", via Sabbionera 45, 33053 Latisana, UD Italy.Emergency and Critical Care Medicine Division, Department of Medicine, Ospedale Civile di Latisana, A.A.S. 2 "Bassa Friulana-Isontina", via Sabbionera 45, 33053 Latisana, UD Italy.Clinica Medica Generale e Terapia Medica, Department of Medical/Surgical Health Sciences, University of Trieste, Strada di Fiume 447, Cattinara, 34149 Trieste, Italy.Emergency and Critical Care Medicine Division, Department of Medicine, Ospedale Civile di Latisana, A.A.S. 2 "Bassa Friulana-Isontina", via Sabbionera 45, 33053 Latisana, UD Italy.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27635166

Citation

Orso, Daniele, et al. "Accuracy of the Caval Index and the Expiratory Diameter of the Inferior Vena Cava for the Diagnosis of Dehydration in Elderly." Journal of Ultrasound, vol. 19, no. 3, 2016, pp. 203-9.
Orso D, Guglielmo N, Federici N, et al. Accuracy of the caval index and the expiratory diameter of the inferior vena cava for the diagnosis of dehydration in elderly. J Ultrasound. 2016;19(3):203-9.
Orso, D., Guglielmo, N., Federici, N., Cugini, F., Ban, A., Mearelli, F., & Copetti, R. (2016). Accuracy of the caval index and the expiratory diameter of the inferior vena cava for the diagnosis of dehydration in elderly. Journal of Ultrasound, 19(3), 203-9. https://doi.org/10.1007/s40477-016-0200-y
Orso D, et al. Accuracy of the Caval Index and the Expiratory Diameter of the Inferior Vena Cava for the Diagnosis of Dehydration in Elderly. J Ultrasound. 2016;19(3):203-9. PubMed PMID: 27635166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of the caval index and the expiratory diameter of the inferior vena cava for the diagnosis of dehydration in elderly. AU - Orso,Daniele, AU - Guglielmo,Nicola, AU - Federici,Nicola, AU - Cugini,Francesco, AU - Ban,Alessio, AU - Mearelli,Filippo, AU - Copetti,Roberto, Y1 - 2016/04/08/ PY - 2015/11/19/received PY - 2016/03/10/accepted PY - 2016/9/17/entrez PY - 2016/9/17/pubmed PY - 2017/2/6/medline KW - Dehydration KW - Elderly KW - Emergency KW - Ultrasound KW - Vena cava SP - 203 EP - 9 JF - Journal of ultrasound JO - J Ultrasound VL - 19 IS - 3 N2 - PURPOSE: Dehydration is a very common condition among elderly people. Till date there is not yet a fast and easy method to determine a state of dehydration in the emergency department. In the literature there are some exploratory studies that have tried to establish the relationship between some widely used laboratory values and ultrasound for the purpose of diagnosing dehydration. The primary aim of this study is to verify the correlation between two measures derived by ultrasound (caval index and expiratory diameter of inferior vena cava) and blood urea nitrogen (BUN)/creatinine ratio. The relationship between vital signs and BUN/creatinine ratio has also been explored. METHODS: An observational cohort study of patients aged 70 years or more, all examined in our ED. The population was divided on the basis of the BUN/creatinine ratio greater or lower than 20. RESULTS: A total of 270 patients have been considered. No vital sign correlated with an increased BUN/creatinine ratio. Both the diameter of the inferior vena cava in expiratory and the percentage of its collapsibility in inspiratory (caval index) have revealed a correlation with a BUN/creatinine ratio greater than 20. Areas under the curve are, respectively, 76 % (95 % CI 70-82) and 80 % (95 % CI 75-86). Sensitivity, specificity, positive predictive value and negative predictive value are, respectively, 85.5 % (95 % CI 79.4-90.4); 100 % (95 % CI 97-100); 100 % (95 % CI 97.5-100); 82.9 % (95 % CI 75.9-88.7) and 99.3 % (95 % CI 96.3-99.9); 100 % (95 % CI 97-100); 100 % (95 % CI 97.5-100); 99.2 % (95 % CI 95.6-99.9). CONCLUSIONS: Ultrasound has proved to be useful to diagnose dehydration in elderly people while in the emergency department. Vice versa the vital signs have shown to be unrelated to the hydration state of elderly patients. SN - 1876-7931 UR - https://www.unboundmedicine.com/medline/citation/27635166/Accuracy_of_the_caval_index_and_the_expiratory_diameter_of_the_inferior_vena_cava_for_the_diagnosis_of_dehydration_in_elderly_ L2 - https://dx.doi.org/10.1007/s40477-016-0200-y DB - PRIME DP - Unbound Medicine ER -