Serin Mustafa Emin, Ozluer Yunus Emre, Kıy Mehmet, Avcil Mucahit
Emergency Medicine, Nevsehir State Hospital, Nevsehir, TUR.
Emergency Medicine, Adnan Menderes University, Aydin, TUR.
Cureus. 2022 Jul 14;14(7):e26840. doi: 10.7759/cureus.26840. eCollection 2022 Jul.
Aim To determine whether left ventricular outflow tract peak velocity is useful for the prediction of mortality in the early phase of sepsis or septic shock. Materials and methods Patients who were hospitalized in the emergency intensive care unit (ED-ICU) with the diagnosis of sepsis or septic shock were consecutively enrolled into two groups (sepsis and septic shock groups) between January 2020 to February 2021. Patients who are pregnant and ≤18 years old were excluded. Demographics, vital parameters, the presence of mechanical ventilation, and vasopressor/inotropic support with the doses of the drugs used were recorded. Ultrasonographic measurements included bedside caval indexes and left ventricular outflow tract (LVOT) peak velocity measurements. The primary outcome was in-hospital and 28th-day mortality. Results A total of 116 patients with a median age of 72.5 (27 to 96) years were enrolled. Sixty-eight (58.6%) patients were male. According to a receiver operating characteristic (ROC) curve analysis, 75 cm/s was determined as a cut-off value to determine the efficacy of LVOT peak velocity measurement for discriminating septic shock from sepsis and predicting 28-day and in-hospital mortality. The patients were then regrouped as 54 (46.5%) patients in low and 62 (53.5%) patients in high-velocity groups according to the cut-off value. Both in-hospital and 28th-day mortality rates were significantly different between these groups (p<0.001). Conclusion Left ventricular outflow tract peak velocity measurement may be a useful adjunct for the prediction of mortality in septic patients. Vasopressors and volume status of the patient do not affect LVOT peak velocity measurements.
目的 确定左心室流出道峰值速度是否有助于预测脓毒症或脓毒性休克早期的死亡率。材料与方法 2020年1月至2021年2月期间，将在急诊重症监护病房（ED-ICU）住院且诊断为脓毒症或脓毒性休克的患者连续纳入两组（脓毒症组和脓毒性休克组）。排除怀孕及年龄≤18岁的患者。记录人口统计学资料、生命体征参数、机械通气情况以及血管升压药/正性肌力药物支持情况及所用药物剂量。超声测量包括床旁腔静脉指数和左心室流出道（LVOT）峰值速度测量。主要结局指标为住院期间及第28天的死亡率。结果 共纳入116例患者，中位年龄为72.5（27至96）岁。68例（58.6%）为男性。根据受试者工作特征（ROC）曲线分析，确定75 cm/s为区分脓毒性休克与脓毒症以及预测28天和住院期间死亡率的LVOT峰值速度测量的临界值。然后根据该临界值将患者重新分组为低速组54例（46.5%）和高速组62例（53.5%）。两组的住院期间及第28天死亡率均有显著差异（p<0.001）。结论 左心室流出道峰值速度测量可能是预测脓毒症患者死亡率的有用辅助指标。血管升压药和患者的容量状态不影响LVOT峰值速度测量。
