Accuracy of indices of inferior vena cava in predicting fluid responsiveness in patients with shock: A systematic review and meta-analysis

Abstract

Objectives

To synthesise quantitative research findings on the accuracy of inferior vena cava (IVC) indices in judging fluid responsiveness (FR) in patients with shock.

Methods

A total of nine electronic databases were searched from inception to April 8, 2024. The risk of bias of the included studies was evaluated by Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A meta-analysis of the values of external validations of the model was performed by Stata 16.0. Pooled estimates were calculated according to the true positive, false positive, false negative, true negative, sensitivity, and specificity using random-effects models. Meta-regression was adopted to investigate between-study heterogeneity, and funnel plots were tested for publication bias.

Results

Twenty-nine studies were included in the meta-analysis (1833 patients). For FR, the sensitivity was 0.82 (95 %CI, 0.75–0.87), specificity was 0.82 (95 % CI, 0.77–0.87), positive likelihood ratio was 4.58 (95 %CI, 3.48–6.03), negative likelihood ratio was 0.22 (95 %CI, 0.16–0.31), diagnostic odds ratio was 20.65 (95 %CI, 12.84–33.14), and the area under the summary receiver operating characteristic curve was 0.89 (95 % CI, 0.86–0.91). All studies had a low or moderate risk of bias in terms of methodological quality. There was heterogeneity among the included studies (sensitivity: I² = 83.04 %, P < 0.001, specificity: I² = 78.78 %, P < 0.001), and bivariate meta-regression analysis showed that fluid infusion ingredient, reference standards and thresholds, and type of measurement (invasive or non-invasive) were sources of literature heterogeneity.

Conclusion

The IVC indices moderately predicted the incidence of FR in patients with shock. However, significant heterogeneity was evident among the included studies. Studies of high methodological quality in specific subgroups of shock are needed to evaluate the efficacy of IVC indices as predictors of FR.

Implications for Clinical Practice

Monitoring of the inferior vena cava (IVC) by ultrasonography has been shown to have a clinical value in terms of volume reactivity, with the potential to provide non-invasive and effective guidance.