Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock.
Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock.
复制标题
严重败血症患者和败血性休克患者的心室舒张功能障碍的预后价值。
DOI：
10.5935/0103-507x.20150057
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发表时间：
2015-10
影响因子：
--
通讯作者：
Dubin A
中科院分区：
文献类型：
--
作者：
Rolando G;Espinoza ED;Avid E;Welsh S;Pozo JD;Vazquez AR;Arzani Y;Masevicius FD;Dubin A
探讨严重脓毒症和脓毒性休克患者心肌功能不全的发生率及其预后价值。 对入住重症监护室的成人脓毒症患者进行前瞻性研究，在入院后的前48小时内以及此后的第7 - 10天内使用经胸超声心动图。比较存活者和非存活者的双心室功能的超声心动图变量，包括E/e'比值。 对53例平均年龄为74岁（SD 13）的患者共进行了99次超声心动图检查（入院时53次，第7 - 10天46次）。分别有14例（26%）和42例（83%）患者存在收缩期和舒张期功能障碍，12例（23%）患者同时存在两种功能障碍。根据ROC曲线下面积（0.71），E/e'比值（舒张功能不全的指数）是医院死亡率的最佳预测因子，并且是多变量分析确定的结局的独立预测因子（OR = 1.36 [1.05 - 1.76]，p = 0.02）。 在重症监护病房的脓毒症患者中，超声心动图收缩功能障碍与死亡率增加无关。相反，舒张功能障碍是一个独立的预测结果。
To evaluate the prevalence of myocardial dysfunction and its prognostic value in patients with severe sepsis and septic shock. Adult septic patients admitted to an intensive care unit were prospectively studied using transthoracic echocardiography within the first 48 hours after admission and thereafter on the 7th-10th days. Echocardiographic variables of biventricular function, including the E/e' ratio, were compared between survivors and non-survivors. A total of 99 echocardiograms (53 at admission and 46 between days 7 - 10) were performed on 53 patients with a mean age of 74 (SD 13) years. Systolic and diastolic dysfunction was present in 14 (26%) and 42 (83%) patients, respectively, and both types of dysfunction were present in 12 (23%) patients. The E/e' ratio, an index of diastolic dysfunction, was the best predictor of hospital mortality according to the area under the ROC curve (0.71) and was an independent predictor of outcome, as determined by multivariate analysis (OR = 1.36 [1.05 - 1.76], p = 0.02). In septic patients admitted to an intensive care unit, echocardiographic systolic dysfunction is not associated with increased mortality. In contrast, diastolic dysfunction is an independent predictor of outcome.