To assess the value of the hepatocervical reflux test (HRT) in assessing volume responsiveness in patients with septic shock.

A prospective cohort study was performed to assess the volume status of patients with septic shock. Using the cardiac output variability (ΔCO_VE) obtained by pulse-directed continuous cardiac output measurement (PiCCO) combined with volume expansion (VE) as the gold standard, ΔCO_VE≥15% was defined as positive fluid responsiveness, otherwise it was defined as negative fluid responsiveness. All the patients underwent the VE test and HRT test to obtain flow dynamics parameters, including heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), cardiac output (CO), and stroke volume (SV) (HRT 15 s and 60 s data were included), which were compared with ΔCO_VE metallographic to obtain correlated indexes. The value of HRT-induced ΔCO_HRT and ΔSV_HRT to predict volume responsiveness was evaluated by receiver operating characteristic (ROC) curve analysis.

Of the 60 patients with septic shock, 36 had positive fluid responsiveness and 24 had negative fluid responsiveness. There was no significant difference in the general clinical data between the two groups (P>0.05). Compared with the baseline value 1 before HRT, the positive fluid responsiveness group had significantly increased CVP, CO, and SV after HRT 15 s [CVP (8.9±2.1) cmH₂O vs (7.8±1.9) cmH₂O, CO (3.7±0.7) L/min vs (3.4±0.7) L/min, SV (30.2±6.2) mL vs (27.2±6.7) mL, P<0.05], but the negative fluid responsiveness group had no significant change (P>0.05). There were no significant difference in HR, MAP, CVP, CO and SV between HRT 60 s with HRT 15 s. In the VE test, compared with baseline value 2 before rehydration, MAP, CVP, CO, and SV in the positive fluid responsiveness group significantly increased after rehydration [MAP: (75.7±7.3) mmHg vs (72.0±7.6) mmHg, CVP: (9.1±1.5) cmH₂O vs (8.0±1.8) cmH₂O, CO: (3.8±0.7) L/min vs (3.5±0.6) L/min, SV: (30.2±5.6) ml vs (27.2±6.7) ml, P<0.05]. Correlation analysis showed that ΔCO_HRT and ΔSV_HRT after VE showed a correlation with ΔCO_VE (r=0.82 and 0.83, respectively, P<0.01). What′s more, in the HRT, with ΔCO_HRT=11.7% as the threshold, the area under the curve of HRT for predicting volume reactivity was 0.95±0.03 (95%CI: 0.903~1.00, P<0.01), with a sensitivity of 91.7% and specificity of 87.5%; with ΔSV_HRT=12.7% as the threshold, the area under the curve was 0.942±0.03 (95% CI: 0.884~0.999, P<0.01), with a sensitivity of 83.3% and specificity of 91.7%.

The HRT is a new method for assessing the volume reactivity by using the principle of autologous infusion. It is a non-invasive, easy-to-use, and reliable method for assessing the volume status of patients with septic shock, which is worthy of clinical application.