Dong Jun, White Seth, Nielsen Kirsten, Banchs Jose, Wang Jian, Botz Gregory H, Nates Joseph L
Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Intensive Care Unit department, Peking University Cancer Hospital & Institute, Beijing, China.
Intern Med J. 2021 Nov;51(11):1854-1861. doi: 10.1111/imj.14957. Epub 2021 Oct 24.
Cardiac dysfunction is a common sequela in patients with sepsis and multi-organ dysfunction. Echocardiography is commonly used in the investigation of circulatory failure.
We aimed to evaluate the prognostic value of echocardiographic parameters in patients with septic shock.
This study was a retrospective trial. We included patients who were admitted to intensive care unit (ICU) with septic shock. The patients' echocardiograms, clinical data and outcomes were obtained from their medical records. Associations between echocardiogram variables and mortality were assessed using logistic regression, controlled for age, sex, body mass index and the interval between the ICU admission and echocardiogram. The utility of statistically significant echocardiogram variables to predict mortality were assessed using receiver operating characteristic (ROC) curves.
The outcomes presented that tricuspid annular plane systolic excursion (TAPSE) was statistically significantly associated with both ICU (P = 0.02) and 90-day (P = 0.001) mortality. From the ROC curves, TAPSE emerged a significant and moderate predictor for 90-day (area under curve (AUC) = 0.69, 95% CI = 0.565-0.814) and in-ICU mortality (AUC = 0.762, 95% CI = 0.652-0.871). The optimal cut-off for TAPSE was 2.1 cm for both 90-day mortality (sensitivity of 80% and specificity and 58%) and in-ICU mortality (sensitivity of 69% and specificity of 77%).
TAPSE was associated with increased mortality in those with sepsis and suspicion of cardiac dysfunction. This is a hypothesis generating article that an association may be present and requires significant more work with expansion to the entire population base.
心脏功能障碍是脓毒症和多器官功能障碍患者常见的后遗症。超声心动图常用于循环衰竭的检查。
我们旨在评估超声心动图参数在感染性休克患者中的预后价值。
本研究为回顾性试验。我们纳入了入住重症监护病房（ICU）的感染性休克患者。从他们的病历中获取患者的超声心动图、临床数据和结局。使用逻辑回归评估超声心动图变量与死亡率之间的关联，并对年龄、性别、体重指数以及入住ICU至超声心动图检查的时间间隔进行控制。使用受试者工作特征（ROC）曲线评估具有统计学意义的超声心动图变量预测死亡率的效用。
结果表明，三尖瓣环平面收缩期位移（TAPSE）与ICU死亡率（P = 0.02）和90天死亡率（P = 0.001）均具有统计学显著相关性。从ROC曲线来看，TAPSE是90天死亡率（曲线下面积（AUC）= 0.69，95%可信区间 = 0.565 - 0.814）和ICU内死亡率（AUC = 0.762，95%可信区间 = 0.652 - 0.871）的显著且中等强度的预测指标。对于90天死亡率（敏感性为80%，特异性为58%）和ICU内死亡率（敏感性为69%，特异性为77%），TAPSE的最佳截断值均为2.1 cm。
TAPSE与脓毒症且怀疑有心脏功能障碍患者的死亡率增加相关。这是一篇提出假设的文章，表明可能存在关联，并且需要对更多人群进行大量研究以进一步证实。
