中重度急性呼吸窘迫综合征患者早期经胸超声心动图与长期死亡率：对重症监护医疗信息集市数据库的分析。

Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database.

机构信息

Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.

State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Sci Prog. 2023 Oct-Dec;106(4):368504231201229. doi: 10.1177/00368504231201229.

DOI:10.1177/00368504231201229

PMID:37801611

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10560446/

Abstract

BACKGROUND

The clinical use of transthoracic echocardiography (TTE) in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) has dramatically increased, its impact on long-term prognosis in these patients has not been studied. This study aimed to explore the effect of early-TTE on long-term mortality in patients with moderate-to-severe ARDS in ICU.

METHODS

A total of 2833 patients with moderate-to-severe ARDS who had or had not received early-TTE were obtained from the Medical Information Mart for Intensive Care (MIMIC-III) database after imputing missing values by a random forest model, patients were divided into early-TTE group and non-early-TTE group according to whether they received TTE examination in ICU. A variety of statistical methods were used to balance 41 covariates and increase the reliability of this study, including propensity score matching, inverse probability of treatment weight, covariate balancing propensity score, multivariable regression, and doubly robust estimation. Chi-Square test and t-tests were used to examine the differences between groups for categorical and continuous data, respectively.

RESULTS

There was a significant improvement in 90-day mortality in the early-TTE group compared to non-early-TTE group (odds ratio = 0.79, 95% CI: 0.64-0.98, -value = 0.036), revealing a beneficial effect of early-TTE. Net-input was significantly decreased in the early-TTE group on the third day of ICU admission and throughout the ICU stay, compared with non-early-TTE group (838.57 vs. 1181.89 mL, -value = 0.014; 4542.54 vs. 8025.25 mL, -value = 0.05). There was a significant difference in the reduction of serum lactate between the two groups, revealing the beneficial effect of early-TTE (0.59 vs. 0.83, -value = 0.009). Furthermore, the reduction in the proportion of acute kidney injury demonstrated a correlation between early-TTE and kidney protection (33% vs. 40%, -value < 0.001).

CONCLUSIONS

Early application of TTE is beneficial to improve the long-term mortality of patients with moderate-to-severe ARDS.

摘要

背景

经胸超声心动图（TTE）在重症监护病房（ICU）急性呼吸窘迫综合征（ARDS）患者中的临床应用显著增加，但尚未研究其对这些患者长期预后的影响。本研究旨在探讨 ICU 中中重度 ARDS 患者早期 TTE 对长期死亡率的影响。

方法

通过随机森林模型对医学信息集市用于重症监护（MIMIC-III）数据库中的 2833 例中重度 ARDS 患者缺失值进行插补后，获得了接受或未接受早期 TTE 的患者，根据患者在 ICU 是否接受 TTE 检查将其分为早期 TTE 组和非早期 TTE 组。采用倾向性评分匹配、逆概率处理权重、协变量平衡倾向评分、多变量回归和双重稳健估计等多种统计方法平衡 41 个协变量，以提高本研究的可靠性。卡方检验和 t 检验分别用于检验分类数据和连续数据的组间差异。

结果

早期 TTE 组 90 天死亡率较非早期 TTE 组显著降低（比值比 = 0.79，95%可信区间：0.64-0.98，-值 = 0.036），提示早期 TTE 有益。与非早期 TTE 组相比，早期 TTE 组 ICU 入院第 3 天和整个 ICU 住院期间的净输入明显减少（838.57 与 1181.89 mL，-值 = 0.014；4542.54 与 8025.25 mL，-值 = 0.05）。两组间血清乳酸下降差异有统计学意义，提示早期 TTE 有益（0.59 与 0.83，-值 = 0.009）。此外，急性肾损伤比例的降低表明早期 TTE 与肾脏保护之间存在相关性（33%与 40%，-值 < 0.001）。