经胸超声心动图对重症监护病房老年患者短期预后的影响：基于 MIMIC-III 数据库的回顾性分析。

The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database.

机构信息

Department of Critical Care Medicine, Shanxi Provincial People's Hospital, Taiyuan, China.

Department of Blood Transfusion, First Medical Center, PLA General Hospital, Beijing, China.

出版信息

Ann Palliat Med. 2021 Jul;10(7):7653-7661. doi: 10.21037/apm-21-1713.

DOI:10.21037/apm-21-1713

PMID:34353053

Abstract

BACKGROUND

Elderly patients in the intensive care unit (ICU) often suffer from cardiac function impairment. Real-time monitoring of cardiac function and structural changes has important clinical significance. Transthoracic echocardiography (TTE) is a convenient, intuitive, and non-invasive real-time examination of the heart, and it has been widely used for intensive care patients. This study aims to analyze the impact of TTE on the prognosis of elderly patients in ICU.

METHODS

Data from elderly patients in the ICU was obtained from the MIMIC-III 1.4 database, and they were divided into a TTE examination group and a non-TTE examination group. The baseline data of the two groups were compared, and multiple regression analysis, propensity score (PS), compatibility analysis, and other methods were used to analyze the influence of TTE on the prognosis of elderly patients in ICU.

RESULTS

A total of 8,952 elderly cases were included, comprising 3,280 cases (36.6%) in the TTE group and 5,672 cases (63.4%) in the non-TTE group. The SAPS score (20.34±5.34 vs. 18.74±5.2, t=13.889, P<0.001) and SOFA score (5.10±3.38 vs. 3.82±2.81, t=19.250, P<0.001) of patients in the TTE group were higher than those of non-TTE group. The rate of patients in the TTE group receiving mechanical ventilation (52.10% vs. 34.80%) and vasoactive drugs (29.30% vs. 15.00%) was significantly higher than that in the non-TTE group. In the PS score compatibility cohort, the 28-day mortality rate of patients in the TTE group was 23.4%, and the 28-day mortality rate of patients in the non-TTE group was 28.7%. The adjusted odd ratio (OR) value was 0.76 (95% CI: 0.65-0.87, P<0.001). Analysis of secondary endpoints showed that patients in the TTE group did not use mechanical ventilation and hypertension drugs for a longer period of time than those in the non-TTE group, and the TTE group patients had significantly more fluid input in the first three days after admission to the ICU than in the non-TTE group.

CONCLUSIONS

TTE examination can reduce the 28-day mortality risk of elderly critically ill patients.

摘要

背景

重症监护病房（ICU）的老年患者常伴有心功能损害。实时监测心功能和结构变化具有重要的临床意义。经胸超声心动图（TTE）是一种方便、直观、非侵入性的实时心脏检查方法，已广泛应用于重症监护患者。本研究旨在分析 TTE 对 ICU 老年患者预后的影响。

方法

从 MIMIC-III 1.4 数据库中获取 ICU 老年患者的数据，并将其分为 TTE 检查组和非 TTE 检查组。比较两组的基线数据，采用多回归分析、倾向评分（PS）、匹配分析等方法分析 TTE 对 ICU 老年患者预后的影响。

结果

共纳入 8952 例老年患者，其中 TTE 组 3280 例（36.6%），非 TTE 组 5672 例（63.4%）。TTE 组患者的 SAPS 评分（20.34±5.34 比 18.74±5.2，t=13.889，P<0.001）和 SOFA 评分（5.10±3.38 比 3.82±2.81，t=19.250，P<0.001）均高于非 TTE 组。TTE 组患者接受机械通气（52.10%比 34.80%）和血管活性药物（29.30%比 15.00%）的比例明显高于非 TTE 组。在 PS 评分匹配队列中，TTE 组患者 28 天死亡率为 23.4%，非 TTE 组患者 28 天死亡率为 28.7%。校正后比值比（OR）值为 0.76（95%CI：0.65-0.87，P<0.001）。对次要终点的分析表明，TTE 组患者使用机械通气和高血压药物的时间均长于非 TTE 组，且 TTE 组患者在入住 ICU 的前三天内输入的液体量明显多于非 TTE 组。