Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
Department of Emergency Medicine, Integrative Biosciences Center, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
PLoS One. 2022 Jul 8;17(7):e0269814. doi: 10.1371/journal.pone.0269814. eCollection 2022.
The goal of this study was to explore the association cardiac function at Emergency Department (ED) presentation prior to the initiation of resuscitation, and its change at 3-hours, with adverse outcomes in patients with sepsis.
This was a prospective observational study of patients presenting to an urban ED with suspected sepsis. Patients had a point-of-care echocardiogram performed prior to initiation of resuscitation and again 3 hours later. Left-ventricular (LV) parameters recorded included e', and E/e', and ejection fraction (EF); right-ventricular (RV) function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Logistic and generalized linear regression were used to assess the association of echocardiographic parameters and ≥ 2-point increase in SOFA score at 24 hours (primary outcome) and 24-hours SOFA score and in-hospital mortality (secondary outcomes).
For ΔSOFA ≥ 2 and 24-hour SOFA score, declining LVEF was associated with better outcomes in patients with greater baseline SOFA scores, but worse outcomes in patients with lower baseline scores. A similar relationship was found for ΔTAPSE at 3 hours. Reduced LVEF at presentation was associated with increased mortality after adjusting for ED SOFA score (odds-ratio (OR) 0.76 (CI 0.60-0.96). No relationship between diastolic parameters and outcomes was found. IVF administration was similar across ΔLVEF/TAPSE sub-groups.
Our results suggest that early change in LV and RV systolic function are independently prognostic of sepsis illness severity at 24-hours. Further study is needed to determine if this information can be used to guide treatment and improve outcomes.
本研究旨在探讨在开始复苏前急诊科（ED）就诊时的心脏功能及其在复苏后 3 小时的变化与脓毒症患者不良结局的关系。
这是一项对就诊于城市 ED 的疑似脓毒症患者进行的前瞻性观察性研究。患者在开始复苏前和 3 小时后进行床边超声心动图检查。记录左心室（LV）参数包括 e'和 E/e'以及射血分数（EF）；使用三尖瓣环平面收缩期位移（TAPSE）评估右心室（RV）功能。使用逻辑回归和广义线性回归评估超声心动图参数与 24 小时时 SOFA 评分增加≥2 分（主要结局）和 24 小时 SOFA 评分和住院死亡率（次要结局）的关系。
对于 ΔSOFA≥2 和 24 小时 SOFA 评分，在基线 SOFA 评分较高的患者中，LVEF 下降与更好的结局相关，但在基线评分较低的患者中，LVEF 下降与更差的结局相关。在 3 小时时也发现了类似的关系。在调整 ED SOFA 评分后，入院时 LVEF 降低与死亡率增加相关（优势比（OR）0.76（95%CI 0.60-0.96）。未发现舒张参数与结局之间存在关系。IVF 给药在 ΔLVEF/TAPSE 亚组之间相似。
我们的结果表明，LV 和 RV 收缩功能的早期变化独立预测 24 小时时脓毒症严重程度。需要进一步研究以确定是否可以利用这些信息来指导治疗并改善结局。
