prediction of hospital outcome in septic shock a prospective comparison of tissue doppler and cardiac biomarkers医院结果预测脓毒性休克前瞻性比较的组织多普勒和心脏生物标记物.pdfVIP

Sturgess et al. Critical Care 2010, 14:R44 /content/14/2/R44 RESEARCH Open Access Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers 1,2* 1,3 1,4 1,3 5 1 4 David J Sturgess , Thomas H Marwick , Chris Joyce , Carly Jenkins , Mark Jones , Paul Masci , David Stewart , Bala Venkatesh1,2,4 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