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Intensive Care Med. 2018 Jun;44(6):884-892. doi: 10.1007/s00134-018-5208-7. Epub 2018 May 28.

Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database.

Author information

1
Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore.
2
Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, USA. jmcsparr@med.umich.edu.
3
Departments of Anesthesiology and Neurosurgery, University of Virginia School of Medicine, Charlottesville, USA.
4
Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, USA.
5
Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France.
6
Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, USA.

Abstract

PURPOSE:

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).

CONCLUSION:

In a general population of critically ill patients with sepsis, use of TTE is associated with an improvement in 28-day mortality.

KEYWORDS:

Critical care; Echocardiography; Sepsis; Value

PMID:
29806057
DOI:
10.1007/s00134-018-5208-7
[Indexed for MEDLINE]

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