Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis
Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis
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DOI：
10.1007/s00134-019-05596-z
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发表时间：
2019-05-01
影响因子：
38.9
通讯作者：
Vieillard-Baron, Antoine
中科院分区：
文献类型：
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作者：
Geri, Guillaume;Vignon, Philippe;Vieillard-Baron, Antoine
目的循环衰竭的机制很复杂，并且在感染性休克中通常很复杂。更好的表征有助于优化血流动力学支持。方法将来自 12 个不同 ICU 的两个已发表的前瞻性数据库（包括感染性休克初始阶段经食管途径进行的超声心动图监测）合并起来进行事后分析。主成分方法中的层次聚类用于使用临床和超声心动图参数来定义心血管表型。对缺失数据进行了估算。 结果 分析中总共纳入了 360 名患者（中位年龄 64 [55; 74]）。定义了五个不同的组：复苏良好的患者（组 1，n=61，16.9%），无左心室（LV）收缩功能障碍、右心室（RV）衰竭或液体反应性、左心室收缩功能障碍患者（组 2，n=64，17.7%）、运动过度患者（组 3，n=84，23.3%）、右心室衰竭患者（组 3，n=84，23.3%）。 4，n=81，22.5%）和持续性血容量不足的患者（5，n=70，19.4%）。第 7 天死亡率分别为 9.8%、32.8%、8.3%、27.2% 和 23.2%，而第 1、2、3、4 和 5 组中 ICU 死亡率分别为 21.3%、50.0%、23.8%、42.0% 和 38.6% (p
PurposeMechanisms of circulatory failure are complex and frequently intricate in septic shock. Better characterization could help to optimize hemodynamic support.MethodsTwo published prospective databases from 12 different ICUs including echocardiographic monitoring performed by a transesophageal route at the initial phase of septic shock were merged for post hoc analysis. Hierarchical clustering in a principal components approach was used to define cardiovascular phenotypes using clinical and echocardiographic parameters. Missing data were imputed.FindingsA total of 360 patients (median age 64 [55; 74]) were included in the analysis. Five different clusters were defined: patients well resuscitated (cluster 1, n=61, 16.9%) without left ventricular (LV) systolic dysfunction, right ventricular (RV) failure or fluid responsiveness, patients with LV systolic dysfunction (cluster 2, n=64, 17.7%), patients with hyperkinetic profile (cluster 3, n=84, 23.3%), patients with RV failure (cluster 4, n=81, 22.5%) and patients with persistent hypovolemia (cluster 5, n=70, 19.4%). Day7 mortality was 9.8%, 32.8%, 8.3%, 27.2%, and 23.2%, while ICU mortality was 21.3%, 50.0%, 23.8%, 42.0%, and 38.6% in clusters 1, 2, 3, 4, and 5, respectively (p