Central venous pressure monitoring and mortality: What was neglected?
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LETTER
Central venous pressure monitoring and mortality: What was neglected? Shaowei Gao, Zhanxin Du, Lu Yang and Zhongxing Wang*
Dear editor, We are interested in the recent published article about the association between central venous pressure (CVP) monitoring and mortality for ICU patients with sepsis [1]. The study provides new insights into this traditional monitoring. However, an important factor might make the study more convincing if it had been taken into account. The clinical experience tells us that ICU admissions after surgeries (surgical patients in the ICU) are more likely to have central venous catheters than those from the medical system (medical patients in the ICU). Besides, as has been proven by many studies, medical patients have worse prognosis than surgical patients in the ICU [2–4]. Chen and his colleagues collected tens of important covariates to adjust the results, but the admission resource (from surgical or medical systems, which can be identified with the official codes [5]) was neglected [1]. To validate our supposition, we conducted an analysis in the same database. According to the inclusion and exclusion criteria of Chen’s study, we extracted a very similar (10,131) but not identical (10,275) cohort (because we didn’t get the authors’ original codes). The CVP monitoring group has 4,505 patients (vs. 4516 in Chen’s study), while the non-CVP monitoring group has 5626 ones (vs. 5759 in Chen’s study). As shown in the mosaic plot (Fig. 1a), CVP monitoring is positively associated with ICU admissions after surgery (1574/4505 [35%] for CVP group vs 835/5626 [15%] for non-CVP group, Phi coefficient = 0.235, p
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