School of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.
Crit Care. 2010;14(2):R44. doi: 10.1186/cc8931. Epub 2010 Mar 24.
Diastolic dysfunction as demonstrated by tissue Doppler imaging (TDI), particularly E/e' (peak early diastolic transmitral/peak early diastolic mitral annular velocity) is common in critical illness. In septic shock, the prognostic value of TDI is undefined. This study sought to evaluate and compare the prognostic significance of TDI and cardiac biomarkers (B-type natriuretic peptide (BNP); N-terminal proBNP (NTproBNP); troponin T (TnT)) in septic shock. The contribution of fluid management and diastolic dysfunction to elevation of BNP was also evaluated.
Twenty-one consecutive adult patients from a multidisciplinary intensive care unit underwent transthoracic echocardiography and blood collection within 72 hours of developing septic shock.
Mean +/- SD APACHE III score was 80.1 +/- 23.8. Hospital mortality was 29%. E/e' was significantly higher in hospital non-survivors (15.32 +/- 2.74, survivors 9.05 +/- 2.75; P = 0.0002). Area under ROC curves were E/e' 0.94, TnT 0.86, BNP 0.78 and NTproBNP 0.67. An E/e' threshold of 14.5 offered 100% sensitivity and 83% specificity. Adjustment for APACHE III, cardiac disease, fluid balance and grade of diastolic function, demonstrated E/e' as an independent predictor of hospital mortality (P = 0.019). Multiple linear regression incorporating APACHE III, gender, cardiac disease, fluid balance, noradrenaline dose, C reactive protein, ejection fraction and diastolic dysfunction yielded APACHE III (P = 0.033), fluid balance (P = 0.001) and diastolic dysfunction (P = 0.009) as independent predictors of BNP concentration.
E/e' is an independent predictor of hospital survival in septic shock. It offers better discrimination between survivors and non-survivors than cardiac biomarkers. Fluid balance and diastolic dysfunction were independent predictors of BNP concentration in septic shock.
组织多普勒成像（TDI）显示的舒张功能障碍，特别是 E/e'（舒张早期二尖瓣口血流速度峰值/舒张早期二尖瓣环速度峰值）在危重病中很常见。在感染性休克中，TDI 的预后价值尚未确定。本研究旨在评估和比较 TDI 与心脏生物标志物（B 型利钠肽（BNP）；N 末端脑利钠肽前体（NTproBNP）；肌钙蛋白 T（TnT））在感染性休克中的预后意义。还评估了液体管理和舒张功能障碍对 BNP 升高的贡献。
21 名连续来自多学科重症监护病房的成年患者在发生感染性休克后 72 小时内接受了经胸超声心动图和血液采集。
平均 +/- SD 的 APACHE III 评分 80.1 +/- 23.8。医院死亡率为 29%。医院幸存者的 E/e' 显著更高（15.32 +/- 2.74，幸存者 9.05 +/- 2.75；P = 0.0002）。ROC 曲线下面积 E/e' 为 0.94，TnT 为 0.86，BNP 为 0.78，NTproBNP 为 0.67。E/e' 阈值为 14.5 时，灵敏度为 100%，特异性为 83%。调整 APACHE III、心脏病、液体平衡和舒张功能分级后，E/e' 被证明是医院死亡率的独立预测因子（P = 0.019）。纳入 APACHE III、性别、心脏病、液体平衡、去甲肾上腺素剂量、C 反应蛋白、射血分数和舒张功能障碍的多元线性回归显示，APACHE III（P = 0.033）、液体平衡（P = 0.001）和舒张功能障碍（P = 0.009）是 BNP 浓度的独立预测因子。
E/e' 是感染性休克患者医院生存的独立预测因子。它比心脏生物标志物更能区分幸存者和非幸存者。液体平衡和舒张功能障碍是感染性休克中 BNP 浓度的独立预测因子。
