Clinical Research On Risk Factors Of Capillary Leak Syndrome

Background and Objective Capillary leak syndrome (CLS) is a syndrome ofhypoproteinemia, decreased blood volume, acute renal ischemia in clinicalmanifestations because of the cell injury of capillary endothelial, increased vascularpermeability with a large number of plasma proteins leaking into the tissues of smallmolecule clearance. Critically ill patients will be in CLS when in serious infection ortrauma, after cardiopulmonary bypass, in mechanical ventilation, drug toxicity,inflammatory mediators, and so on. Patients in CLS will be with progressive systemicedema, hypoproteinemia, weight gained, blood concentration rapidly and be multipleorgan failure in serious condition. The CLS incidence rate shows an increasing trendand CLS is a serious threat to critically ill patients. When patients in CLS, it willmake their condition deterioration rapidly, treat difficultly and have mortality highly.Patients’ morbidity and mortality will further increase if clinicians can not understandthe CLS’s risk factors and affecting prognosis factors correctly. So, it will helpclinicians understanding of CLS by discussing critically ill patients’ CLS incidence,the relationship with primary disease, risk factors and affecting prognosis factors. Itwill be positive to CLS effective prevention, timely diagnosis and early treatment.Then it can avoid or reduce the occurrence of the CLS, control the progression of theCLS, reduce the mortality of patients and improve the cure rate.Methods This study analyze the medical records of191CLS patients within2690cases in the Anhui provincial hospital’s ICU from Jan.2005to Aug.2010retrospectively. The clinical datum included of their vital signs, blood biochemistry,blood routine test, arterial blood gas analysis and urine routine on admission andCLS’s onset, and recorded the patients’ CVP and MAP, estimated APACHEⅡ,MODS and SIRS score. Compared the clinical data on admission with that when CLS occurred and analyzed the risk factors of CLS．According to their prognosis, thepatients with CLS were divided into the cured group (132cases), the none-curedgroup (22cases) and the death group (37cases). Their clinical data of death groupwas compared with that of cured group on admission, occurring CLS and beforedischarging from hospital and explored the prognostic factors. Normal distributiondata was indicated by±s and used two independent sample T-test, nonnormaldistribution data was indicated by median（P25，P75）and used two independentsample rank sum test. The comparison of the datum in two groups was conducted byusing Χ2test, the correlation analysis between two factors used linear correlationanalysis, and the analysis of multi-factors used logistic regression analysis. Allanalyzed with statistical software SPSS13.0.Results The incidence rate of CLS in ICU was7.10%. Compared with the clinicaldata on admission, When CLS occurred, their temperature was higher (P<0.01),respiratory rate was faster (P<0.05), white blood cell count and neutrophil percentageincreased (P<0.01), blood platelet count decreased (P<0.01), urinary pH and inspiredoxygen concentration increased (P<0.01), the oxygenation index and pressure-adjusted heart rate (PAHR) decreased (P<0.05,0.01), serum calcium concentrationsand anion gap (AG) decreased (P<0.05), blood osmotic pressure increased (P<0.01),serum alanine aminotransferase, aspartate aminotransferase and glutamyltranspeptidase was higher (P<0.01,0.05). The score of SIRS, APACHEⅡ and MODSis higher (P<0.01)．Compared with the cured group, the central venous pressure andserum albumin decreased (P<0.01); AG, triglycerides, PAHR and oxygenation indexwere lower (P<0.01,0.05); serum glucose and SIRS score increased (P<0.01) in deathgroup. There were many patients with poor renal function on admission in deathgroup (P<0.01). The more patients were treated with hydroxyethyl starch injection,ulinastatin and blood purification therapy in cured group (P <0.05).Conclusions The incidence rate of CLS was not rare in critically ill patients. Thecommon risk factors of CLS were increased systemic inflammation, aggravated theprimary disease, thrombocytopenia, hypocalcemia and so on. The function of liver, kidney and other important organ would be injured when CLS occurred．Theinfluence factors on prognosis of the patients with CLS had hypovolemia, severehypoproteinemia, internal milieu disorder, malnutrition, hypoxemia, kidney injury andsevere systemic inflammatory response. It could improve the prognosis of patientswith CLS in ICU, using hydroxyethyl starch, ulinastatin and blood purificationtherapy.