Eke Onyinyechi F, Jalbout Nour Al, Selame Lauren, Gullikson Jamie, Deng Hao, Shokoohi Hamid
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Intern Emerg Med. 2024 Sep;19(6):1757-1764. doi: 10.1007/s11739-024-03682-9. Epub 2024 Jun 22.
Few clinical decision rules have been used to guide clinical management and predict outcomes in patients with pericardial tamponade. The objectives of this study are to identify the echocardiographic features associated with adverse outcomes in patients with pericardial effusions requiring pericardiocentesis and to apply a previously described four-point clinical and echocardiographic score to predict clinical outcomes over 24-hr, 30-day, and 1-year intervals. We performed a retrospective cohort review of patients who had transthoracic echocardiogram (TTE) performed and underwent pericardiocentesis within 48 h of emergency department presentation at two large tertiary care institutions. We constructed different stepwise logistic regression models and examined the associations of TTE characteristics and clinical features with ICU admission, hospital length of stay (h-LOS), and survival. The data set was then employed against a previously proposed scoring system to predict factors associated with clinical outcomes over 24 hr, 30 days, and 1 year. Two hundred thirty-nine patients were included in the final analysis. Echocardiographic characteristics of patients with pericardial tamponade who underwent pericardiocentesis are as follows: 69.1% right ventricular (RV) diastolic collapse, 62.3% exaggerated mitral valve (MV) inflow velocities, 56.4% inferior vena cava (IVC) plethora, and 53.4% right atrial (RA) systolic collapse. Increase in systolic blood pressure and increased variation in MV inflow velocity were associated with reduced ICU admission [OR: 0.94 (CI 0.90, 0.99), 0.28 (CI 0.09, 0.89), respectively]. In addition, a history of malignancy increased the length of hospital stay by about 3.89 days (CI 1.43-6.35, p < 0.01) and prior pericardiocentesis history was associated with 4.82-day increase in hospital stay (CI 1.19-8.45, p = 0.01). In utilizing the previously published prediction score, we found no statistically significant correlation in predicting survival. RV diastolic collapse and exaggerated MV inflow velocity were the most common echocardiographic findings in patients requiring pericardiocentesis. Contrary to prior studies, exaggerated MV inflow velocity was associated with reduced ICU admission. In addition, a previously described prediction score did not correlate with decreased survival in this cohort.
很少有临床决策规则被用于指导心包填塞患者的临床管理和预测其预后。本研究的目的是确定需要心包穿刺术的心包积液患者中与不良预后相关的超声心动图特征，并应用先前描述的四点临床和超声心动图评分来预测24小时、30天和1年期间的临床结局。我们对两家大型三级医疗机构急诊科就诊后48小时内接受经胸超声心动图（TTE）检查并接受心包穿刺术的患者进行了回顾性队列研究。我们构建了不同的逐步逻辑回归模型，并研究了TTE特征和临床特征与入住重症监护病房（ICU）、住院时间（h-LOS）和生存率之间的关联。然后将数据集应用于先前提出的评分系统，以预测24小时、30天和1年期间与临床结局相关的因素。最终分析纳入了239例患者。接受心包穿刺术的心包填塞患者的超声心动图特征如下：右心室（RV）舒张期塌陷69.1%，二尖瓣（MV）流入速度增加62.3%，下腔静脉（IVC）充血56.4%，右心房（RA）收缩期塌陷53.4%。收缩压升高和MV流入速度变化增加与ICU入住率降低相关[比值比（OR）分别为：0.94（95%置信区间[CI]0.90，0.99），0.28（CI 0.09，0.89）]。此外，恶性肿瘤病史使住院时间延长约3.89天（CI 1.43 - 6.35，p<0.01），心包穿刺术既往史与住院时间延长4.82天相关（CI 1.19 - 8.45，p = 0.01）。在使用先前发表的预测评分时，我们发现在预测生存率方面没有统计学上的显著相关性。RV舒张期塌陷和MV流入速度增加是需要心包穿刺术患者最常见的超声心动图表现。与先前的研究相反，MV流入速度增加与ICU入住率降低相关。此外，先前描述的预测评分与该队列中生存率降低无关。
