Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database
Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database
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DOI：
10.1007/s00134-018-5208-7
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发表时间：
2018-06-01
影响因子：
38.9
通讯作者：
Celi, Leo Anthony
中科院分区：
文献类型：
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作者：
Feng, Mengling;McSparron, Jakob I.;Celi, Leo Anthony
虽然经胸超声心动图（TTE）在ICU中的应用正在迅速扩大，但TTE对ICU脓毒症患者预后的影响尚未得到研究。本研究旨在研究TTE与28天死亡率的关系，特别是在该人群中，MIMIC-III数据库用于识别接受和未接受TTE治疗的脓毒症患者。采用的统计方法包括多元回归，倾向得分分析，双重稳健估计，梯度提升模型，和逆概率加权模型，以确保我们的研究结果的鲁棒性。与对照组（无TTE）相比，TTE患者在28天死亡率方面观察到显著获益（比值比= 0.78，95%CI 0.68-0.90，p < 0.001）。TTE患者的输液量（第1天2.5 vs 2.1 L，p < 0.001）、多巴酚丁胺的使用（2% vs 1%，p = 0.007）和去甲肾上腺素的最大剂量（1.4 vs 1 mg/min，p = 0.001）显著较高。重要的是，TTE组患者比非TTE组患者更快地脱离血管加压药（21天中的第28天无血管加压药对第19天，p = 0.004）。在脓毒症危重患者的一般人群中，使用TTE与28天死亡率的改善相关。
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.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.