Early transthoracic echocardiography and long-term mortality in moderate to severe ARDS: analysis of the MIMIC-III database

Abstract

Abstract Background While the use of transthoracic echocardiography (TTE) in the intensive care unit (ICU) is rapidly expanding, the contribution of early-TTE to altering patient outcomes among ICU patients with acute respiratory distress syndrome (ARDS) has not been examined. This study aimed to analyze the effect of early TTE on long-term mortality in patients with moderate to severe ARDS in ICU. Methods We obtain 3425 moderate-to-severe ARDS patients who had or had not received early TTE from MIMIC-III database, after imputing missing values through the random forest model, to guarantee that our findings were robust, we utilized a variety of statistical methods including propensity score matching (PSM), inverse probability of treatment weight (IPTW), covariate balancing propensity score (CBPS), multivariable regress, doubly robust estimation to balance 39 covariates and evaluate the effect of early TTE on long-term mortality. We used t-tests for continuous outcomes and χ2 tests for categorical outcomes. Results Early-TTE group’s 90-day mortality exhibited a significant improvement comparing to non-early-TTE group (odds ratio = 0.77 95% CI 0.63–0.94, p-value = 0.009)), which reveal its beneficial effect. On the third day of ICU admission and throughout the hospital stay, the early-TTE group had considerably decreased net-input (845.37 vs. 1156.78 mL and 8353.90 vs. 4877.25 mL). The serum creatinine reduction exhibited a significant difference between these two groups and revealed the early-TTE’s beneficial effect on the kidney (0.57 vs. 0.84, p-value = 0.003). Conclusions Early application of TTE is beneficial to improving the long-term mortality of patients with moderate to severe ARDS.