Early transthoracic echocardiography improves in-hospital mortality and fluid resuscitation in septic ICU patients with impaired cardiac function.

BACKGROUND

Transthoracic echocardiography (TTE) is increasingly utilized in the intensive care unit (ICU), yet the optimal timing of TTE in sepsis remains unclear.

OBJECTIVE

To examine the impact of early versus late TTE on mortality and fluid resuscitation, stratified by left ventricular ejection fraction (LVEF).

METHODS

We conducted a retrospective cohort study using the MIMIC-III database. Septic ICU patients who underwent TTE were included. Unmatched and overlap-weighted matched analyses were performed. Multivariable logistic regression assessed in-hospital mortality, and Cox regression evaluated 1-year mortality. LVEF was categorized as severe (<30%), moderate (30-39%), mild (40-49%), or normal (≥50%).

RESULTS

Of 10,232 patients, 3145 (30.7%) and 4116 (40.2%) received early TTE within 6 and 12 h, respectively. In-hospital mortality was lower in patients with TTE within 6 h (12.1% vs. 17.2%, P < 0.001). Early TTE was associated with reduced in-hospital mortality (adjusted odds ratio [OR] 0.77, 95% CI 0.67-0.88, P < 0.001; overlap-weighted OR 0.78, 95% CI 0.68-0.89, P < 0.003). No association was observed with 1-year mortality. Early TTE was linked to greater 24-hour fluid administration in patients with impaired LVEF: mild (median 3109 mL vs. 2107 mL, P < 0.001), moderate (2587 mL vs. 1840 mL, P < 0.001), and severe (2193 mL vs. 1839 mL, P = 0.002), but not in those with normal LVEF. Similar findings were observed when TTEs were performed within 12 h.

CONCLUSIONS

Early TTE in sepsis is associated with greater fluid resuscitation in those with impaired LVEF and with reduced in-hospital mortality.