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Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers
Citation
Sturgess, DJ and Marwick, TH and Joyce, C and Jenkins, C and Jones, M and Masci, P and Stewart, D and Venkatesh, B, Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers, Critical Care, 14, (2) Article R44. ISSN 1466-609X (2010) [Refereed Article]
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Copyright Statement
Copyright 2010 the Authors
DOI: doi:10.1186/cc8931
Abstract
Introduction: Diastolic dysfunction as demonstrated by tissue Doppler imaging (TDI), particularly E/e’ (peak early
diastolic transmitral/peak early diastolic mitral annular velocity) is common in critical illness. In septic shock, the
prognostic value of TDI is undefined. This study sought to evaluate and compare the prognostic significance of TDI
and cardiac biomarkers (B-type natriuretic peptide (BNP); N-terminal proBNP (NTproBNP); troponin T (TnT)) in septic
shock. The contribution of fluid management and diastolic dysfunction to elevation of BNP was also evaluated.
Methods: Twenty-one consecutive adult patients from a multidisciplinary intensive care unit underwent transthoracic echocardiography and blood collection within 72 hours of developing septic shock.
Results: Mean ± SD APACHE III score was 80.1 ± 23.8. Hospital mortality was 29%. E/e’ was significantly higher in hospital non-survivors (15.32 ± 2.74, survivors 9.05 ± 2.75; P = 0.0002). Area under ROC curves were E/e’ 0.94, TnT 0.86, BNP 0.78 and NTproBNP 0.67. An E/e’ threshold of 14.5 offered 100% sensitivity and 83% specificity. Adjustment for APACHE III, cardiac disease, fluid balance and grade of diastolic function, demonstrated E/e’ as an independent predictor of hospital mortality (P = 0.019). Multiple linear regression incorporating APACHE III, gender, cardiac disease, fluid balance, noradrenaline dose, C reactive protein, ejection fraction and diastolic dysfunction yielded APACHE III (P = 0.033), fluid balance (P = 0.001) and diastolic dysfunction (P = 0.009) as independent predictors of BNP concentration.
Conclusions: E/e’ is an independent predictor of hospital survival in septic shock. It offers better discrimination between survivors and non-survivors than cardiac biomarkers. Fluid balance and diastolic dysfunction were independent predictors of BNP concentration in septic shock.
Methods: Twenty-one consecutive adult patients from a multidisciplinary intensive care unit underwent transthoracic echocardiography and blood collection within 72 hours of developing septic shock.
Results: Mean ± SD APACHE III score was 80.1 ± 23.8. Hospital mortality was 29%. E/e’ was significantly higher in hospital non-survivors (15.32 ± 2.74, survivors 9.05 ± 2.75; P = 0.0002). Area under ROC curves were E/e’ 0.94, TnT 0.86, BNP 0.78 and NTproBNP 0.67. An E/e’ threshold of 14.5 offered 100% sensitivity and 83% specificity. Adjustment for APACHE III, cardiac disease, fluid balance and grade of diastolic function, demonstrated E/e’ as an independent predictor of hospital mortality (P = 0.019). Multiple linear regression incorporating APACHE III, gender, cardiac disease, fluid balance, noradrenaline dose, C reactive protein, ejection fraction and diastolic dysfunction yielded APACHE III (P = 0.033), fluid balance (P = 0.001) and diastolic dysfunction (P = 0.009) as independent predictors of BNP concentration.
Conclusions: E/e’ is an independent predictor of hospital survival in septic shock. It offers better discrimination between survivors and non-survivors than cardiac biomarkers. Fluid balance and diastolic dysfunction were independent predictors of BNP concentration in septic shock.
Item Details
| Item Type: | Refereed Article |
|---|---|
| Research Division: | Biomedical and Clinical Sciences |
| Research Group: | Cardiovascular medicine and haematology |
| Research Field: | Cardiology (incl. cardiovascular diseases) |
| Objective Division: | Health |
| Objective Group: | Clinical health |
| Objective Field: | Clinical health not elsewhere classified |
| UTAS Author: | Marwick, TH (Professor Tom Marwick) |
| ID Code: | 90874 |
| Year Published: | 2010 |
| Web of Science® Times Cited: | 98 |
| Deposited By: | Menzies Institute for Medical Research |
| Deposited On: | 2014-04-30 |
| Last Modified: | 2014-05-01 |
| Downloads: | 526 View Download Statistics |
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