Effect of Transthoracic Echocardiography on Short-term Outcomes in Patients with Acute Kidney Injury in the Intensive Care Unit: a Retrospective Cohort Study Based on the MIMIC-III Database

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2022 Aug 29

PMID 36034992

Authors

Caijie Liu

Shuying Wang

Xiuzhen Wang

Affiliations

Soon will be listed here.

Abstract

Background: Acute kidney injury (AKI) is a common problem in the intensive care unit (ICU). Transthoracic echocardiography (TTE) has become a common test in the ICU. But the effect of TTE on the short-term prognosis in ICU patients with AKI remains unclear. We aimed to analyze the relationship between TTE and short-term prognosis in ICU patients with AKI.

Methods: AKI patients in the Medical Information Mart for Intensive Care (MIMIC)-III database were retrospectively enrolled according to inclusion and exclusion criteria, and their clinical information was extracted. TTE was conducted during ICU stay. AKI was diagnosed according to KIDGO criteria. The primary endpoint was the outcome of 28-day ICU stay. The doubly robust estimation method was used to analyze the association of TTE with the primary and secondary outcomes of patients with AKI in ICU. The gradient boosted model (GBM) was used to estimate the propensity score of patients to undergo TTE examination, thereby minimizing the variable imbalance between the TTE and non-TTE groups. Weighted cohorts were built using the inverse probabilities weighting (IPW) model with estimated propensity scores as weights. The weighted cohort was analyzed using logistic regression and validated using other models.

Results: A total of 2,983 patients were included. In the original cohort, 28-day mortality was 37.9% in the TTE group (n=1,684) and 40.8% in the non-TTE group (n=1,299). In the propensity score model (PSM) cohort, 28-day mortality was 34.6% in the TTE group (n=702) and 45.6% in the non-TTE group (n=702). Doubly robust analysis showed that TTE was associated with lower 28-day mortality.

Conclusions: TTE examination might decrease the 28-day mortality in patients with AKI in the ICU and should be considered for critical patients when necessary.

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References

Mehta R, Cerda J, Burdmann E, Tonelli M, Garcia-Garcia G, Jha V . International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015; 385(9987):2616-43. DOI: 10.1016/S0140-6736(15)60126-X. View

Kotecha A, Vallabhajosyula S, Coville H, Kashani K . Cardiorenal syndrome in sepsis: A narrative review. J Crit Care. 2017; 43:122-127. DOI: 10.1016/j.jcrc.2017.08.044. View

Vieillard-Baron A, Millington S, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A . A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med. 2019; 45(6):770-788. DOI: 10.1007/s00134-019-05604-2. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007; 4(10):e296. PMC: 2020495. DOI: 10.1371/journal.pmed.0040296. View

Hoste E, Kellum J, Selby N, Zarbock A, Palevsky P, Bagshaw S . Global epidemiology and outcomes of acute kidney injury. Nat Rev Nephrol. 2018; 14(10):607-625. DOI: 10.1038/s41581-018-0052-0. View

Docherty N, Delles C, DHaese P, Layton A, Martinez-Salgado C, Vervaet B . Haemodynamic frailty - A risk factor for acute kidney injury in the elderly. Ageing Res Rev. 2021; 70:101408. DOI: 10.1016/j.arr.2021.101408. View

Kellum J, Chawla L, Keener C, Singbartl K, Palevsky P, Pike F . The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock. Am J Respir Crit Care Med. 2015; 193(3):281-7. PMC: 4803059. DOI: 10.1164/rccm.201505-0995OC. View

Geneix M, Moschietto S, Frouin A, Depeyre F, Dupont T, Montini F . Echocardiography is a good way to diagnose and monitor type 1 cardiorenal syndrome in ICU. Minerva Anestesiol. 2021; 88(3):137-144. DOI: 10.23736/S0375-9393.21.15708-6. View

Rangaswami J, Bhalla V, Blair J, Chang T, Costa S, Lentine K . Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. 2019; 139(16):e840-e878. DOI: 10.1161/CIR.0000000000000664. View

10.

Johnson A, Pollard T, Shen L, Lehman L, Feng M, Ghassemi M . MIMIC-III, a freely accessible critical care database. Sci Data. 2016; 3:160035. PMC: 4878278. DOI: 10.1038/sdata.2016.35. View

11.

Mitchell C, Rahko P, Blauwet L, Canaday B, Finstuen J, Foster M . Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2018; 32(1):1-64. DOI: 10.1016/j.echo.2018.06.004. View

12.

Feng M, McSparron J, Kien D, Stone D, Roberts D, Schwartzstein R . Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database. Intensive Care Med. 2018; 44(6):884-892. DOI: 10.1007/s00134-018-5208-7. View

13.

Bian Z, Zhu R, Chen S . The predict value of serum/urocystatin C on acute kidney injury in elderly patients with sepsis. Exp Gerontol. 2021; 155:111576. DOI: 10.1016/j.exger.2021.111576. View

14.

Singh Y, Tissot C, Fraga M, Yousef N, Cortes R, Lopez J . International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care. 2020; 24(1):65. PMC: 7041196. DOI: 10.1186/s13054-020-2787-9. View

15.

Kellum J, Lameire N . Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17(1):204. PMC: 4057151. DOI: 10.1186/cc11454. View

16.

Schrezenmeier E, Barasch J, Budde K, Westhoff T, Schmidt-Ott K . Biomarkers in acute kidney injury - pathophysiological basis and clinical performance. Acta Physiol (Oxf). 2016; 219(3):554-572. PMC: 5575831. DOI: 10.1111/apha.12764. View

17.

Xie Y, Ankawi G, Yang B, Garzotto F, Passannante A, Breglia A . Tissue inhibitor metalloproteinase-2 (TIMP-2) • IGF-binding protein-7 (IGFBP7) levels are associated with adverse outcomes in patients in the intensive care unit with acute kidney injury. Kidney Int. 2019; 95(6):1486-1493. DOI: 10.1016/j.kint.2019.01.020. View

18.

Main M, Hibberd M, Ryan A, Lowe T, Miller P, Bhat G . Acute mortality in critically ill patients undergoing echocardiography with or without an ultrasound contrast agent. JACC Cardiovasc Imaging. 2013; 7(1):40-8. DOI: 10.1016/j.jcmg.2013.08.012. View

19.

Hoste E, Bagshaw S, Bellomo R, Cely C, Colman R, Cruz D . Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015; 41(8):1411-23. DOI: 10.1007/s00134-015-3934-7. View

20.

Canty D, Royse C, Kilpatrick D, Bowyer A, Royse A . The impact on cardiac diagnosis and mortality of focused transthoracic echocardiography in hip fracture surgery patients with increased risk of cardiac disease: a retrospective cohort study. Anaesthesia. 2012; 67(11):1202-9. DOI: 10.1111/j.1365-2044.2012.07300.x. View