Liu Caijie, Wang Shuying, Wang Xiuzhen
Department of Ultrasound, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
Department of Blood Transfusion, First Medical Center, PLA General Hospital, Beijing, China.
Ann Transl Med. 2022 Aug;10(15):826. doi: 10.21037/atm-22-3158.
Acute kidney injury (AKI) is a common problem in the intensive care unit (ICU). Transthoracic echocardiography (TTE) has become a common test in the ICU. But the effect of TTE on the short-term prognosis in ICU patients with AKI remains unclear. We aimed to analyze the relationship between TTE and short-term prognosis in ICU patients with AKI.
AKI patients in the Medical Information Mart for Intensive Care (MIMIC)-III database were retrospectively enrolled according to inclusion and exclusion criteria, and their clinical information was extracted. TTE was conducted during ICU stay. AKI was diagnosed according to KIDGO criteria. The primary endpoint was the outcome of 28-day ICU stay. The doubly robust estimation method was used to analyze the association of TTE with the primary and secondary outcomes of patients with AKI in ICU. The gradient boosted model (GBM) was used to estimate the propensity score of patients to undergo TTE examination, thereby minimizing the variable imbalance between the TTE and non-TTE groups. Weighted cohorts were built using the inverse probabilities weighting (IPW) model with estimated propensity scores as weights. The weighted cohort was analyzed using logistic regression and validated using other models.
A total of 2,983 patients were included. In the original cohort, 28-day mortality was 37.9% in the TTE group (n=1,684) and 40.8% in the non-TTE group (n=1,299). In the propensity score model (PSM) cohort, 28-day mortality was 34.6% in the TTE group (n=702) and 45.6% in the non-TTE group (n=702). Doubly robust analysis showed that TTE was associated with lower 28-day mortality.
TTE examination might decrease the 28-day mortality in patients with AKI in the ICU and should be considered for critical patients when necessary.
急性肾损伤（AKI）是重症监护病房（ICU）中的常见问题。经胸超声心动图（TTE）已成为ICU中的一项常见检查。但TTE对ICU中AKI患者短期预后的影响仍不明确。我们旨在分析TTE与ICU中AKI患者短期预后之间的关系。
根据纳入和排除标准，对重症监护医学信息数据库（MIMIC）-III中的AKI患者进行回顾性纳入，并提取其临床信息。在ICU住院期间进行TTE检查。根据改善全球肾脏病预后组织（KDIGO）标准诊断AKI。主要终点是ICU住院28天的结局。采用双重稳健估计方法分析TTE与ICU中AKI患者主要和次要结局的关联。使用梯度提升模型（GBM）估计患者接受TTE检查的倾向评分，从而最大限度地减少TTE组和非TTE组之间的变量不平衡。使用以估计倾向评分为权重的逆概率加权（IPW）模型构建加权队列。使用逻辑回归分析加权队列，并使用其他模型进行验证。
共纳入2983例患者。在原始队列中，TTE组（n = 1684）的28天死亡率为37.9%，非TTE组（n = 1299）为40.8%。在倾向评分模型（PSM）队列中，TTE组（n = 702）的28天死亡率为34.6%，非TTE组（n = 702）为45.6%。双重稳健分析表明，TTE与较低的28天死亡率相关。
TTE检查可能会降低ICU中AKI患者的28天死亡率，必要时应对重症患者考虑进行该检查。
