The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database

Baoping Li; Dongwu Shi; Lili Zhu; Ximei Li; Shuying Wang; Feifei Yang; Yu Song; Dongdong Xue; Zhi Mao

doi:10.21037/apm-21-1713

The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database

Ann Palliat Med. 2021 Jul;10(7):7653-7661. doi: 10.21037/apm-21-1713.

Authors

Baoping Li¹, Dongwu Shi¹, Lili Zhu¹, Ximei Li¹, Shuying Wang², Feifei Yang¹, Yu Song¹, Dongdong Xue¹, Zhi Mao³

Affiliations

¹ Department of Critical Care Medicine, Shanxi Provincial People's Hospital, Taiyuan, China.
² Department of Blood Transfusion, First Medical Center, PLA General Hospital, Beijing, China.
³ Department of Critical Care Medicine, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China.

PMID: 34353053
DOI: 10.21037/apm-21-1713

Abstract

Background: Elderly patients in the intensive care unit (ICU) often suffer from cardiac function impairment. Real-time monitoring of cardiac function and structural changes has important clinical significance. Transthoracic echocardiography (TTE) is a convenient, intuitive, and non-invasive real-time examination of the heart, and it has been widely used for intensive care patients. This study aims to analyze the impact of TTE on the prognosis of elderly patients in ICU.

Methods: Data from elderly patients in the ICU was obtained from the MIMIC-III 1.4 database, and they were divided into a TTE examination group and a non-TTE examination group. The baseline data of the two groups were compared, and multiple regression analysis, propensity score (PS), compatibility analysis, and other methods were used to analyze the influence of TTE on the prognosis of elderly patients in ICU.

Results: A total of 8,952 elderly cases were included, comprising 3,280 cases (36.6%) in the TTE group and 5,672 cases (63.4%) in the non-TTE group. The SAPS score (20.34±5.34 vs. 18.74±5.2, t=13.889, P<0.001) and SOFA score (5.10±3.38 vs. 3.82±2.81, t=19.250, P<0.001) of patients in the TTE group were higher than those of non-TTE group. The rate of patients in the TTE group receiving mechanical ventilation (52.10% vs. 34.80%) and vasoactive drugs (29.30% vs. 15.00%) was significantly higher than that in the non-TTE group. In the PS score compatibility cohort, the 28-day mortality rate of patients in the TTE group was 23.4%, and the 28-day mortality rate of patients in the non-TTE group was 28.7%. The adjusted odd ratio (OR) value was 0.76 (95% CI: 0.65-0.87, P<0.001). Analysis of secondary endpoints showed that patients in the TTE group did not use mechanical ventilation and hypertension drugs for a longer period of time than those in the non-TTE group, and the TTE group patients had significantly more fluid input in the first three days after admission to the ICU than in the non-TTE group.

Conclusions: TTE examination can reduce the 28-day mortality risk of elderly critically ill patients.

Keywords: Echocardiography; critical care; elderly; prognosis.

MeSH terms

Aged
Critical Care*
Echocardiography
Humans
Intensive Care Units*
Prognosis
Retrospective Studies