Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database
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Author(s)
Feng, Mengling
McSparron, Jakob I
Kien, Dang T
Stone, David J
Roberts, David H
Schwartzstein, Richard M
Vieillard-Baron, Antoine
Celi, Leo A
Date Issued
May 28, 2018
Publisher
Springer Berlin Heidelberg
Version
Author's final manuscript
Abstract
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.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
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DOI of Published Version
https://doi.org/10.1007/s00134-018-5208-7
