ArticleCureus2025
Limitations of Oral Mucosal Moisture Assessment as an Indicator of Intravascular Dehydration in Postoperative Cardiovascular Surgical Patients in the ICU: A Prospective Pilot Diagnostic Accuracy Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOral mucosal moisture (OMM) measured by using a portable device (Mucus
objectivesTo evaluate the diagnostic accuracy of OMM for hypovolemia in postoperative cardiovascular surgical patients in the intensive care unit (ICU).
methodsThe present single-center, prospective diagnostic accuracy study (Japan, Nov 2024-Sep 2025) enrolled consecutive postoperative cardiovascular surgical adults (≥20 years). OMM (index test) was measured on postoperative day (POD) 2 or on POD 3, if the POD 2 data were unavailable. The reference standard was a composite requiring all of the following conditions: absence of venous congestion (venous excess ultrasound (VExUS) score = 0), at least one low-volume indicator (central venous pressure (CVP) <4 mmHg, small inferior vena cava (IVC) diameter, or positive collapsibility), and a positive left ventricular (LV) "kissing sign," acquired within a two-hour window. The predefined tongue dryness cutoff (<27.9%) and a data-driven Youden threshold were compared. We estimated the sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver-operating characteristic curve with confidence intervals (CIs). Multivariable logistic regression was performed after adjusting for age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and body mass index. Separately, the correlations between OMM and CVP, IVC diameter, VExUS score, and intraoperative water balance were examined.
resultsAmong the 85 eligible patients, 57 were enrolled (age, 66.9 ± 10.7 years; 70.2% were male). The hypovolemia prevalence was 12.3%. At the cutoff Youden index (≤26.1), sensitivity was 0.714 (95% CI 0.290-0.963); specificity, 0.640 (0.492-0.771); positive predictive value (PPV), 0.217 (0.075-0.437); negative predictive value (NPV), 0.941 (0.803-0.993); and AUC, 0.640 (0.476-0.804). At the predefined cutoff (<27.9%), sensitivity was 0.857 (0.421-0.996); specificity, 0.460 (0.318-0.607); PPV, 0.182 (0.070-0.355); and NPV, 0.958 (0.789-0.999). The diagnostic accuracy did not differ between the two thresholds (McNemar p > 0.99). OMM was not independently associated with hypovolemia and showed no significant correlations with CVP, IVC diameter, VExUS score, or intraoperative balance.
conclusionsIn this single-center postoperative cardiac ICU cohort study, OMM showed limited discrimination for hypovolemia and no clear association with intravascular volume. OMM is not supported as a stand-alone screening tool; any interpretation should be coupled with dynamic hemodynamic assessments.
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