Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
PLoS One. 2019 Jan 11;14(1):e0209994. doi: 10.1371/journal.pone.0209994. eCollection 2019.
Echocardiographic parameters have been used to predict outcomes for specific intensive care unit (ICU) populations. We sought to define echocardiographic parameters for ICU patients receiving continuous renal replacement therapy (CRRT).
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: This is a historical cohort study of consecutive ICU patients at Mayo Clinic (Rochester, Minnesota) who received CRRT from December 9, 2006, through November 13, 2015. Only patients with an echocardiographic examination within 7 days of CRRT initiation were considered.
The study included 1,276 patients. Decreased left ventricular ejection fraction (LVEF; ≤45%) was noted in 361/1,120 (32%) and increased right ventricular systolic pressure (RVSP; ≥40 mm Hg) was noted in 529/798 (66%). Right ventricular systolic dysfunction was observed in 320/820 (39%). The most common valvular abnormality was tricuspid regurgitation (244/1,276 [19%]). Stratification of these parameters by ICU type (medical, surgical, cardiothoracic, cardiac) showed that most echocardiographic abnormalities were significantly more prevalent among cardiac ICU patients: LVEF ≤45% (67/105 [64%]), RVSP ≥40 mm Hg (63/79 [80%]) and tricuspid regurgitation (50/130 [38%]). We compared patients with acute kidney injury (AKI) vs end-stage renal disease and showed that decreased LVEF (284/921 [31%] vs 78/201 [39%]), was significantly less prevalent among patients with AKI, but increased RVSP was more prevalent (445/651 [68%] vs 84/147 [57%]) with AKI.
ICU patients who required CRRT had increased prevalence of pulmonary hypertension and right and left ventricular systolic dysfunction. Prediction of adverse outcomes with echocardiographic parameters in this patient population can lead to identification of modifiable risk factors.
超声心动图参数已被用于预测特定重症监护病房（ICU）人群的预后。我们旨在确定接受连续肾脏替代治疗（CRRT）的 ICU 患者的超声心动图参数。
设计、地点、参与者和测量方法：这是梅奥诊所（明尼苏达州罗切斯特）的一项连续 ICU 患者的历史队列研究，这些患者于 2006 年 12 月 9 日至 2015 年 11 月 13 日期间接受 CRRT。仅考虑在 CRRT 开始后 7 天内进行超声心动图检查的患者。
该研究纳入了 1276 名患者。1120 例中有 361 例（32%）存在左心室射血分数（LVEF；≤45%）降低，798 例中有 529 例（66%）存在右心室收缩压（RVSP；≥40mmHg）升高。320 例（39%）存在右心室收缩功能障碍。最常见的瓣膜异常是三尖瓣反流（1276 例中的 244 例[19%]）。按 ICU 类型（内科、外科、心胸外科、心脏）对这些参数进行分层显示，大多数超声心动图异常在心内科 ICU 患者中更为常见：LVEF≤45%（67/105[64%]）、RVSP≥40mmHg（63/79[80%]）和三尖瓣反流（50/130[38%]）。我们比较了急性肾损伤（AKI）与终末期肾病患者，并显示 LVEF 降低（921 例中的 284 例[31%]与 201 例中的 78 例[39%]）在 AKI 患者中明显少见，但 RVSP 更为常见（651 例中的 445 例[68%]与 147 例中的 84 例[57%]）。
需要 CRRT 的 ICU 患者肺动脉高压和左右心室收缩功能障碍的发生率增加。在该患者人群中，超声心动图参数预测不良结局可识别可改变的危险因素。
