Critical care medicine · 2026
Mechanistic Specificity of Capillary Leak Indices: Validation in Heart Failure as a Negative Control.
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Popham Jonathan, Yasmin Farah, Ramani Niranjana, Okifo Kevin, Rao Veena, Testani Jeffrey, Wilson F Perry, Koutroulis Ioannis, Pierce Richard W
Аннотация
OBJECTIVE: To evaluate the mechanistic specificity of capillary leak clinical indices by testing their performance in a heart failure population as a negative control.
DESIGN: Retrospective observational study.
SETTING: Tertiary-care academic medical center.
PATIENTS: Adults with chronic heart failure (both stable outpatients and those with acute decompensation) undergoing clinically indicated blood volume analysis.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Clinical capillary leak indices, Sequential Organ Failure Assessment score, Capillary Leak Index, Vascular Leak Index, and Hematocrit-Albumin Difference, were calculated and compared with the transcapillary escape rate of albumin (TERalb) by Spearman correlation. Across analyses, indices showed weak or absent correlation with TERalb, indicating a lack of mechanistic specificity outside acute inflammatory illness.
CONCLUSIONS: Clinical capillary leak indices do not accurately reflect true capillary permeability in a cohort of patients with chronic and acute-on-chronic heart failure, suggesting that they should be interpreted as context-dependent markers rather than as general measures of endothelial permeability.
DESIGN: Retrospective observational study.
SETTING: Tertiary-care academic medical center.
PATIENTS: Adults with chronic heart failure (both stable outpatients and those with acute decompensation) undergoing clinically indicated blood volume analysis.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Clinical capillary leak indices, Sequential Organ Failure Assessment score, Capillary Leak Index, Vascular Leak Index, and Hematocrit-Albumin Difference, were calculated and compared with the transcapillary escape rate of albumin (TERalb) by Spearman correlation. Across analyses, indices showed weak or absent correlation with TERalb, indicating a lack of mechanistic specificity outside acute inflammatory illness.
CONCLUSIONS: Clinical capillary leak indices do not accurately reflect true capillary permeability in a cohort of patients with chronic and acute-on-chronic heart failure, suggesting that they should be interpreted as context-dependent markers rather than as general measures of endothelial permeability.