Aorta/IVC ratio and dehydration

Two studies this month report a correlation between ultrasound detected aorta/IVC ratio and dehydration in children presenting with diarrhoea and/or vomiting. In both studies the IVC diameter was measured in expiration and the aortic diameter in systole, using a transverse view in the subxiphoid area. Both used acute and post-discharge weight comparison to ascertain degree of dehydration.

The first study took place in Rwanda and a percent weight change between admission and discharge of greater than 10% was considered the criterion standard for severe dehydration. 52 children were included ranging in age from 1 month to 10 year. Vessel diameter measurements were inner wall to inner wall. The IVC-to-aorta ratio correlated significantly with percent weight change (r = 0.435, p < 0.001). Using the best ROC curve cutoff of 1.22, aorta/IVC ratio had a sensitivity of 93% (95% CI = 81% to 100%), specificity of 59% (95% CI = 44% to 75%), LR+ of 2.3 (95%CI=1.5to3.5), and LR– of 0.11 (95%CI=0.02to 0.76) for detecting severe dehydration. The same study did not find ultrasound assessment of inferior vena cava inspiratory collapse or the World Health Organization scale to be accurate predictors of severe dehydration in this same population of children.

Ultrasound Assessment of Severe Dehydration in Children With Diarrhea and Vomiting
Acad Emerg Med. 2010 Oct;17(10):1035-41

The second study took place in the USA. The subjects were considered to have significant dehydration if the weight loss was at least 5%. 71 were children were included. The area under the curve (AUC) was 0.73 (95% CI = 0.61 to 0.84). An IVC ⁄ aorta cutoff of 0.8 produced a sensitivity of 86% and a specificity of 56% for the diagnosis of significant dehydration. The positive predictive value was 56%, and the negative predictive value was 86%. Note this equates to an aorta/IVC ratio of 1.25, similar to that in the first study.

My rough-and-ready take home message from these two studies appears to be that an aorta/IVC ratio less than about 1.2 makes severe dehydration less likely in children with symptoms of gastroenteritis.

Use of Bedside Ultrasound to Assess Degree of Dehydration in Children With Gastroenteritis
Acad Emerg Med. 2010 Oct;17(10):1042-7