Prediction of hospital outcome in septic shock: A prospective comparison of tissue Doppler and cardiac biomarkers

Sturgess, David J., Marwick, Thomas H., Joyce, Chris, Jenkins, Carly, Jones, Mark, Masci, Paul, Stewart, David and Venkatesh, Bala (2010) Prediction of hospital outcome in septic shock: A prospective comparison of tissue Doppler and cardiac biomarkers. Critical Care, 14 2 Article R44: 1-11. doi:10.1186/cc8931

Author Sturgess, David J.
Marwick, Thomas H.
Joyce, Chris
Jenkins, Carly
Jones, Mark
Masci, Paul
Stewart, David
Venkatesh, Bala
Title Prediction of hospital outcome in septic shock: A prospective comparison of tissue Doppler and cardiac biomarkers
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
Publication date 2010
Sub-type Article (original research)
DOI 10.1186/cc8931
Open Access Status DOI
Volume 14
Issue 2 Article R44
Start page 1
End page 11
Total pages 11
Place of publication United Kingdom
Publisher BioMed Central
Collection year 2011
Language eng
Formatted 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.

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.

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.
Keyword Ventricular diastolic function
Brain natriuretic peptide
Incremental prognostic value
Mitral annulus velocity
Systolic heart-failure
Color m-mode
Severe sepsis
Myocardial dysfunction
Filling pressures
Standards committee
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 57 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 70 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Sun, 27 Jun 2010, 00:08:11 EST