Left Ventricle Tissue Doppler Imaging Predicts Disease Severity in Septic Patients Newly Admitted in an Emergency Unit.
BACKGROUND
Assessment of sepsis severity is challenging. Available scoring systems require laboratory data. Therefore, a rapid tool would be useful.


OBJECTIVE
To determine the role of mitral valve tissue Doppler imaging (TDI) as a prognostic tool in septic patients.


METHODS
For this prospective cohort, newly admitted septic patients received TDI measurements of s wave (s), e' wave (e'), and E/e' ratio (E/e') within 5 min of resuscitation. Results were compared with sepsis severity measured by Mortality in Emergency Department Sepsis (MEDS), Simplified Acute Physiology Score (SAPS) 3, and Sequential Organ Failure Assessment (SOFA).


RESULTS
Over 3 months, 63 patients were enrolled. TDI parameters correlated with MEDS, SAPS 3, and SOFA (r = -0.53, r = -0.55, r = -0.36, respectively, for s, p < 0.005; r = -0.56, r = -0.49, r = -0.40, respectively, for e', p < 0.005; and r = 0.56; r = 0.48; r = 0.46, respectively, for E/e', p < 0.005). Mean s and e' decreased among sepsis, severe sepsis, and septic shock patients (14.2; 12.05; 10.14 cm/s, respectively, for s, p = 0.0048 and 18.28; 15.14; 12.12 cm/s, respectively, for e', p = 0.003), whereas mean E/e' increased among sepsis stages (4.76; 6.51; and 8.14, respectively, p = 0.001). Mean s and e' were higher in survivors (13.25 vs. 7.33 cm/s, for s, p < 0.0001; and 16.4 vs. 9 cm/s for e', p = 0.0025); mean E/e' was higher in nonsurvivors (10.85 vs. 5.63, p < 0.0001). On univariate analysis, odds ratios (ORs) for death related to s, e', and E/e' were, respectively, 0.517 (95% confidence interval [CI] 0.344-0.775), 0.60 (95% CI 0.433-0.833), and 1.953 (95% CI 1.256-3.008); p < 0.05 for all. Multiple logistic analysis showed an OR of 1.737 (95% CI 1.037-2.907, p = 0.035) for death related to E/e'.


CONCLUSIONS
TDI may be useful to assess disease severity and prognosis in newly diagnosed septic patients.
School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Thiago Martins
TM
Santos
School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Daniel
D
Franci
School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Marcelo
M
Schweller
School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Diego Lima
DL
Ribeiro
School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Carolina Matida
CM
Gontijo-Coutinho
School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
José Roberto
JR
Matos-Souza
School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Marco Antonio
MA
de Carvalho-Filho
D015150:Echocardiography, Doppler; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012151:Resuscitation; D018805:Sepsis / Q000000981:diagnostic imaging* / Q000628:therapy; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
echocardiography; emergency department; sepsis; tissue Doppler imaging