Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore.
Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, USA.
Intensive Care Med. 2018 Jun;44(6):884-892. doi: 10.1007/s00134-018-5208-7. Epub 2018 May 28.
While the use of transthoracic echocardiography (TTE) in the ICU is rapidly expanding, the contribution of TTE to altering patient outcomes among ICU patients with sepsis has not been examined. This study was designed to examine the association of TTE with 28-day mortality specifically in that population.
The MIMIC-III database was employed to identify patients with sepsis who had and had not received TTE. The statistical approaches utilized included multivariate regression, propensity score analysis, doubly robust estimation, the gradient boosted model, and an inverse probability-weighting model to ensure the robustness of our findings. Significant benefit in terms of 28-day mortality was observed among the TTE patients compared to the control (no TTE) group (odds ratio = 0.78, 95% CI 0.68-0.90, p < 0.001). The amount of fluid administered (2.5 vs. 2.1 L on day 1, p < 0.001), use of dobutamine (2% vs. 1%, p = 0.007), and the maximum dose of norepinephrine (1.4 vs. 1 mg/min, p = 0.001) were significantly higher for the TTE patients. Importantly, the TTE patients were weaned off vasopressors more quickly than those in the no TTE group (vasopressor-free days on day 28 of 21 vs. 19, p = 0.004).
In a general population of critically ill patients with sepsis, use of TTE is associated with an improvement in 28-day mortality.
尽管在 ICU 中使用经胸超声心动图（TTE）的应用正在迅速扩大，但 TTE 对 ICU 中脓毒症患者的预后改变的影响尚未得到检验。本研究旨在专门研究 TTE 与 28 天死亡率之间的关系。
使用 MIMIC-III 数据库来识别接受和未接受 TTE 的脓毒症患者。使用的统计方法包括多变量回归、倾向评分分析、双重稳健估计、梯度提升模型和逆概率加权模型，以确保我们的发现具有稳健性。与对照组（未接受 TTE）相比，TTE 患者在 28 天死亡率方面具有显著的获益（优势比 = 0.78，95%置信区间 0.68-0.90，p < 0.001）。与对照组相比，TTE 患者在第 1 天接受的液体量（2.5 比 2.1 L，p < 0.001）、多巴酚丁胺的使用（2%比 1%，p = 0.007）和去甲肾上腺素的最大剂量（1.4 比 1 mg/min，p = 0.001）均显著更高。重要的是，与对照组相比，TTE 患者更快地停止使用血管加压药（第 28 天无血管加压药天数为 21 比 19，p = 0.004）。
在一般 ICU 中患有脓毒症的危重病患者中，使用 TTE 与 28 天死亡率的改善相关。
