Utility of inferior vena cava diameter ratio on computed tomography scan among low-risk elderly patients in the emergency department

Abstract

Hypovolemia is a major risk factor for morbidity and mortality among elderly older patients. The inferior vena cava (IVC) diameter is known to predict the fluid volume status in ill patients. This study aimed to evaluate the predictive performance of the IVC diameter ratio, as determined by computed tomography (CT), for poor outcomes among low risk patients 65 years of age and older. This single-center retrospective study was conducted on patients who taken CT during the clinical process between January 2019 and December 2020. IVC diameter ratio measurement was estimated by dividing the maximum value of the anteroposterior diameter from the maximum value of transverse diameter at the level right above the renal vein. The IVC diameter ratio’s prognostic performance was evaluated by using the area under the receiver operating characteristic (AUROC) curve. The mean IVC diameter ratio was 1.78. Multivariable logistic regression analysis revealed age, pulse rate, aspartate aminotransferase level, and IVC diameter ratio as significant risk factors for in-hospital death. The area under the receiver operating curve for predicting death using the IVC diameter ratio of patients with pulse rates under 95 was 0.701 and the cut-off value was 1.638, with an 88.9% sensitivity and 45.2% specificity. The odds ratio for higher IVC diameter ratio values was statistically significant (p = 0.031) for predicting in-hospital death. IVC measurement using abdomen& pelvic computed tomography (APCT ) demonstrated capability for predicting poor outcomes, including all-cause mortality among older patients with low risk in the emergency department.