TY - JOUR
T1 - Prediction of hospital outcome in septic shock: A prospective comparison of tissue Doppler and cardiac biomarkers
AU - Sturgess, David J.
AU - Marwick, Thomas H.
AU - Joyce, Chris
AU - Jenkins, Carly
AU - Jones, Mark
AU - Masci, Paul
AU - Stewart, David
AU - Venkatesh, Bala
N1 - Funding Information:
Mr Goce Dimeski (Chemical Pathology, Princess Alexandra Hospital, Queensland Health Pathology Service, Ipswich Road, Brisbane, Australia) assisted with advice regarding biochemical assay techniques. Dr Elaine Beller (School of Population Health, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia) assisted with advice regarding final statistical analysis. This study was conducted with the support of grants from the Australian and New Zealand College of Anaesthetists. This study was performed at the Department of Intensive Care and The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, 4102, Australia.
PY - 2010/3/23
Y1 - 2010/3/23
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=78149236340&partnerID=8YFLogxK
U2 - 10.1186/cc8931
DO - 10.1186/cc8931
M3 - Article
C2 - 20331902
AN - SCOPUS:78149236340
SN - 1364-8535
VL - 14
JO - Critical Care
JF - Critical Care
IS - 2
M1 - R44
ER -