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Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database

BACKGROUND: The clinical use of transthoracic echocardiography (TTE) in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) has dramatically increased, its impact on long-term prognosis in these patients has not been studied. This study aimed to explore the effe...

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Autores principales: Liu, Qiuyu, Tang, Yingkui, Tao, Wu, Tang, Ze, Wang, Hongjin, Nie, Shiyu, Wang, Nian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10560446/
https://www.ncbi.nlm.nih.gov/pubmed/37801611
http://dx.doi.org/10.1177/00368504231201229
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author Liu, Qiuyu
Tang, Yingkui
Tao, Wu
Tang, Ze
Wang, Hongjin
Nie, Shiyu
Wang, Nian
author_facet Liu, Qiuyu
Tang, Yingkui
Tao, Wu
Tang, Ze
Wang, Hongjin
Nie, Shiyu
Wang, Nian
author_sort Liu, Qiuyu
collection PubMed
description BACKGROUND: The clinical use of transthoracic echocardiography (TTE) in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) has dramatically increased, its impact on long-term prognosis in these patients has not been studied. This study aimed to explore the effect of early-TTE on long-term mortality in patients with moderate-to-severe ARDS in ICU. METHODS: A total of 2833 patients with moderate-to-severe ARDS who had or had not received early-TTE were obtained from the Medical Information Mart for Intensive Care (MIMIC-III) database after imputing missing values by a random forest model, patients were divided into early-TTE group and non-early-TTE group according to whether they received TTE examination in ICU. A variety of statistical methods were used to balance 41 covariates and increase the reliability of this study, including propensity score matching, inverse probability of treatment weight, covariate balancing propensity score, multivariable regression, and doubly robust estimation. Chi-Square test and t-tests were used to examine the differences between groups for categorical and continuous data, respectively. RESULTS: There was a significant improvement in 90-day mortality in the early-TTE group compared to non-early-TTE group (odds ratio  =  0.79, 95% CI: 0.64–0.98, p-value  =  0.036), revealing a beneficial effect of early-TTE. Net-input was significantly decreased in the early-TTE group on the third day of ICU admission and throughout the ICU stay, compared with non-early-TTE group (838.57 vs. 1181.89 mL, p-value  =  0.014; 4542.54 vs. 8025.25 mL, p-value  =  0.05). There was a significant difference in the reduction of serum lactate between the two groups, revealing the beneficial effect of early-TTE (0.59 vs. 0.83, p-value  =  0.009). Furthermore, the reduction in the proportion of acute kidney injury demonstrated a correlation between early-TTE and kidney protection (33% vs. 40%, p-value < 0.001). CONCLUSIONS: Early application of TTE is beneficial to improve the long-term mortality of patients with moderate-to-severe ARDS.
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spelling pubmed-105604462023-10-09 Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database Liu, Qiuyu Tang, Yingkui Tao, Wu Tang, Ze Wang, Hongjin Nie, Shiyu Wang, Nian Sci Prog Medicine & Health Sciences BACKGROUND: The clinical use of transthoracic echocardiography (TTE) in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) has dramatically increased, its impact on long-term prognosis in these patients has not been studied. This study aimed to explore the effect of early-TTE on long-term mortality in patients with moderate-to-severe ARDS in ICU. METHODS: A total of 2833 patients with moderate-to-severe ARDS who had or had not received early-TTE were obtained from the Medical Information Mart for Intensive Care (MIMIC-III) database after imputing missing values by a random forest model, patients were divided into early-TTE group and non-early-TTE group according to whether they received TTE examination in ICU. A variety of statistical methods were used to balance 41 covariates and increase the reliability of this study, including propensity score matching, inverse probability of treatment weight, covariate balancing propensity score, multivariable regression, and doubly robust estimation. Chi-Square test and t-tests were used to examine the differences between groups for categorical and continuous data, respectively. RESULTS: There was a significant improvement in 90-day mortality in the early-TTE group compared to non-early-TTE group (odds ratio  =  0.79, 95% CI: 0.64–0.98, p-value  =  0.036), revealing a beneficial effect of early-TTE. Net-input was significantly decreased in the early-TTE group on the third day of ICU admission and throughout the ICU stay, compared with non-early-TTE group (838.57 vs. 1181.89 mL, p-value  =  0.014; 4542.54 vs. 8025.25 mL, p-value  =  0.05). There was a significant difference in the reduction of serum lactate between the two groups, revealing the beneficial effect of early-TTE (0.59 vs. 0.83, p-value  =  0.009). Furthermore, the reduction in the proportion of acute kidney injury demonstrated a correlation between early-TTE and kidney protection (33% vs. 40%, p-value < 0.001). CONCLUSIONS: Early application of TTE is beneficial to improve the long-term mortality of patients with moderate-to-severe ARDS. SAGE Publications 2023-10-06 /pmc/articles/PMC10560446/ /pubmed/37801611 http://dx.doi.org/10.1177/00368504231201229 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Medicine & Health Sciences
Liu, Qiuyu
Tang, Yingkui
Tao, Wu
Tang, Ze
Wang, Hongjin
Nie, Shiyu
Wang, Nian
Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database
title Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database
title_full Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database
title_fullStr Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database
title_full_unstemmed Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database
title_short Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database
title_sort early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: an analysis of the medical information mart for intensive care database
topic Medicine & Health Sciences
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10560446/
https://www.ncbi.nlm.nih.gov/pubmed/37801611
http://dx.doi.org/10.1177/00368504231201229
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