Prediction of Mortality in Septic Shock; Comparison of Tissue Doppler and Different Biomarkers

Background: Assessment of the diastolic dysfunction by tissue Doppler imaging (TDI) and cardiac biomarkers such as B-type natriutic peptide BNP together can be a good tools for prediction of hospital outcome in septic shock patients.Purpose: To evaluate and compare the prognostic significance of (TDI) particularly E/é (peak early diastolic transmitral/peak early diastolic mitral annular velocity), cardiac biomarkers (N- terminal proBNP (NTproBNP); cardiac troponin I (cTnI)) and high sensitive C- reactive protein (hs CRP) in septic shock.Methodology: Twenty eight patients with septic shock were involved in a prospective randomized clinical study (mean age were 62±9.3 yrs, 62% male) were divided into 2 groups according to mortality and were subjected to all fluid resuscitation, transthoracic echocardiography TTE and laboratory measurement of the mentioned cardiac biomarkers.Results: There were 20 pt (71.4%) died Group A, 8 patients (28.6%) survived Group B. E/é ratio was significantly lower in survivors than non-survivors (8.59±2.29 vs.12.32±2.37, p-value = 0.001), hs CRP was found to be significantly lower between survivals and non survivals (33.49±10.82 vs. 41.65±7.33, p-value = 0.02). There was a strong positive correlation between E/e and (PMR, DT, LA size and FiO2) (p-value = 0.002, 0.0001, 0.007 and 0.003 r=0.5, 0.6 respectively). There was a positive correlation between hs-CRP with both (PMR and DT) (p-value = 0.01 and 0.03, r=0.4 respectively). By cox regression analysis 5 parameters were found to be independent predictors of mortality in septic shock which were: E/e ratio, APACHE IV, SOFA 1, SOFA 3 and DT as p-value (0.009, 0.002, 0.003, 0.007 and 0.0001) respectively.Conclusions: E/é and DT obtained by PW and TDI both offer independent and better prognostic prediction of hospital outcome in septic shock as compared with cardiac biomarkers (NT, proBNP cTnI).