Utilization of echocardiography during septic shock was associated with a decreased 28-day mortality: a propensity score-matched analysis of the MIMIC-III database

Abstract

Background: Hemodynamic management is of paramount importance in patients with septic shock.Echocardiography has been increasingly used in assessing volume status and cardiac function. However, whether the utilization of echocardiography has an impact on prognosis is unknown. Thus, we intended to explore its effect on the outcomes of patients with septic shock. Methods:The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database.Septic shock patients were divided into two groups according to the usage of echocardiography during the onset of septic shock. The primary outcome was 28-day mortality. Secondary outcomes included the usage of inotropes, ventilation-free and norepinephrine-free time, and fluids input. Propensity-score matching was used to reduce the imbalance.Results: Among 3,291 eligible patients, 1,289 patients who underwent echocardiography (Echo), and 1,289 who did not receive the Echo, had similar propensity scores and were included in the analyses. After matching, the Echo group had a significantly lower 28-day mortality (33.2% vs. 37.7%, P=0.019). More patients in the Echo group received pulmonary artery catheter (PAC) (4.2% vs. 0.2%, P<0.001) and inotropes (17.8% vs. 7.1%, P<0.001). In the survival analysis, Echo utilization was associated with improved 28-day mortality [hazard ratio (HR): 0.83; 95% confidence interval (CI), 0.73-0.95, P=0.005]. A reduced likelihood of 28-day mortality in patients with Echo vs. those without Echo was maintained either when excluding patients receiving multiple echocardiography scans (HR, 0.82; 95% CI, 0.72-0.94; P=0.004) or when excluding patients undergoing PAC or pulse index continuous cardiac output (PiCCO) (HR, 0.87; 95% CI, 0.76-0.99; P=0.034).Conclusions: Utilization of echocardiography was associated with improved 28-day outcomes in patients with septic shock.

Critical care echocardiography: diagnostic or prognostic?

“…In this study, CCE was associated with a significantly lower 28-day mortality in septic patients from the MIMIC-III database, irrespective of the five models tested (5). In the present contribution, Lan et al (3) reported that after matching, septic patients from the same database more frequently received right-heart catheterization but not transpulmonary thermodilution when assessed using CCE. This suggests that those specific patients, who were sicker than their counterparts before matching, required a comprehensive hemodynamic assessment and monitoring according to their clinical presentation.…”

“…authors showed that 28-day mortality was significantly lower in the ultrasound group (33.2% vs. 37.7%: P=0.019). Improved 28-day mortality in patients assessed with CCE (OR: 0.83; 95% CI: 0.73-0.95: P=0.005) was confirmed by sensitivity analyses in the subgroup of patients who underwent a single echocardiography examination (n=2,464; OR: 0.82; 95% CI: 0.72-0.94; P=0.004) and when excluding patients monitored using either a rightheart catheter or transpulmonary thermodilution (n=2,485; OR: 0.87; 95% CI: 0.76-0.99: P=0.034) (3). These results confirm those reported by the previous contribution of Feng et al (5) based on the same Medical Information Mart for Intensive Care (MIMIC)-III database in 6,361 patients with sepsis.…”

“…In the two recent studies reporting an improved 28-day mortality in septic patients from the MIMIC-III data base who were initially assessed using CCE, a significant therapeutic impact presumably related to initial noninvasive hemodynamic assessment has been described (3,5). When compared to patients who were not evaluated by CCE, those patients who underwent an echocardiography assessment during the initial management of sepsis received significantly more fluids throughout the first three days of hospitalization (5), more inotropes (3,5), and shorter duration of vasopressors (5). In contrast, the duration of mechanical ventilation was not statistically different between groups (3,5).…”

Integrated Multiorgan Bedside Ultrasound for the Diagnosis and Management of Sepsis and Septic Shock

“…Additional studies specifically involving patients with septic shock suggest a mortality benefit when formal echocardiography is performed. 11,12 These data are promising, as they highlight the potential clinical impact of bedside cardiac ultrasound in the assessment of critically ill patients when performed by experienced practitioners.…”

Utilization of Echocardiography After Acute Kidney Injury Was Associated with Improved Outcomes in Patients in Intensive Care Unit

“… 13 In contrast, in the two latest studies, usage of TTE was proved to be associated with a significant improvement in 28-day mortality in patients with sepsis. 14 , 15 Moreover, limited data are available regarding the association between TTE utilization and improved clinical outcomes in patients after AKI, given the superiorities of TTE in the management of fluid balance. Hence, in the current study, we hypothesized that TTE usage after AKI might improve prognosis among patients with AKI because it may facilitate hemodynamic stabilization.…”