Left Ventricle Tissue Doppler Imaging Predicts Disease Severity in Septic Patients Newly Admitted in an Emergency Unit

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