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Research Article - Current Trends in Cardiology (2018) Volume 2, Issue 1
Integral Role of Transthoracic Echocardiography and Clinical Predictors of Mortality in Septic Shock Patients.
There is conflicting data on the prognostic value of transthoracic echocardiographic (TTE)- determined diastolic function in critically ill patients with septic shock. We sought to identify the echocardiographic and clinical predictors of in-hospital and 90-day outcomes in septic shock. 248 consecutive patients admitted to the ICU with septic shock were retrospectively studied. Comprehensive baseline characteristics were obtained. Multivariable analysis was used to identify independent predictors of mortality. Mean age was 64.9 ± 18 years (51% men), and mortality rate was 23% in the ICU and 33% within 90 days of hospital admission. Multivariate analysis revealed 3 independent predictors of ICU mortality: ratio of mitral E wave to early diastolic velocity of medial mitral annulus (E/e’) (odds ratio [OR]: 1.04, 95% CI: 1.0-1.08, P<0.05), APACHE II score (OR: 1.07, 95% CI: 1.0-1.1, P<0.05) and lactate levels (OR: 1.37, 95% CI: 1.2-1.6, P<0.05). Patients with E/e’ medial ratio >15 had 3.78 times the odds (95% CI: 1.87, 7.65) of ICU mortality compared to patients with E/e’ <15 (P=0.0002). Independent predictors of 90-day mortality were advanced age (OR: 1.02, 95% CI: 1.0-1.04, P<0.05), urine output (OR: 1.13, 95% CI: 1.1-1.2, P<0.05), low hematocrit (OR: 0.93, 95% CI: 0.88-0.98, P<0.05) and inferior vena cava size (dilated versus normal: OR: 2.02, 95% CI: 1.05-3.85, P<0.05). Our study reemphasized the usefulness of E/e’ in critically ill patients, negating prior reports of the lack of value of this parameter.
Author(s): Sagger Mawri, Karthikeyan Ananthasubramaniam, Alexander Michaels, Joseph Gibbs, Abdelrahim Elsheikh, Waleed Al-Darzi, Saba Assar, Rami Dirani, Yasser Alsafadi, Jainil Shah, Derar Albashaireh