Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database
- 2.1k Downloads
While the use of transthoracic echocardiography (TTE) in the ICU is rapidly expanding, the contribution of TTE to altering patient outcomes among ICU patients with sepsis has not been examined. This study was designed to examine the association of TTE with 28-day mortality specifically in that population.
Methods and results
The MIMIC-III database was employed to identify patients with sepsis who had and had not received TTE. The statistical approaches utilized included multivariate regression, propensity score analysis, doubly robust estimation, the gradient boosted model, and an inverse probability-weighting model to ensure the robustness of our findings. Significant benefit in terms of 28-day mortality was observed among the TTE patients compared to the control (no TTE) group (odds ratio = 0.78, 95% CI 0.68–0.90, p < 0.001). The amount of fluid administered (2.5 vs. 2.1 L on day 1, p < 0.001), use of dobutamine (2% vs. 1%, p = 0.007), and the maximum dose of norepinephrine (1.4 vs. 1 mg/min, p = 0.001) were significantly higher for the TTE patients. Importantly, the TTE patients were weaned off vasopressors more quickly than those in the no TTE group (vasopressor-free days on day 28 of 21 vs. 19, p = 0.004).
In a general population of critically ill patients with sepsis, use of TTE is associated with an improvement in 28-day mortality.
KeywordsEchocardiography Sepsis Value Critical care
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no competing interests.
- 4.Society of Critical Care Medicine (2018) Critical care statistics. http://www.sccm.org/Communications/Pages/CriticalCareStats.aspx. Accessed 8 Feb 2018
- 14.Douglas PS, Garcia MJ, Haines DE et al (2011) ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr 24:229–267. https://doi.org/10.1016/j.echo.2010.12.008 CrossRefPubMedGoogle Scholar
- 15.Ward RP, Krauss D, Mansour IN et al (2009) Comparison of the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography appropriateness criteria for outpatient transthoracic echocardiography in academic and community practice settings. J Am Soc Echocardiogr 22:1375–1381. https://doi.org/10.1016/j.echo.2009.08.005 CrossRefPubMedGoogle Scholar
- 18.STROBE Group (2016) STROBE statement: home. http://www.strobe-statement.org/index.php?id=strobe-home. Accessed 12 Dec 2016
- 26.Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
- 31.Yu DT, Platt R, Lanken PN et al (2003) Relationship of pulmonary artery catheter use to mortality and resource utilization in patients with severe sepsis. Crit Care Med 31:2734–2741. https://doi.org/10.1097/01.CCM.0000098028.68323.64 CrossRefPubMedGoogle Scholar