Left ventricle tissue doppler imaging predicts disease severity in septic patients newly admitted in an emergency unit

Abstract

Assessment of sepsis severity is challenging. Available scoring systems require laboratory data. Therefore, a rapid tool would be useful. To determine the role of mitral valve tissue Doppler imaging (TDI) as a prognostic tool in septic patients. 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). 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′. TDI may be useful to assess disease severity and prognosis in newly diagnosed septic patients.