Cardiopulmonary Ultrasound to Predict Care Escalation in Early Sepsis
Authors
Hani I. Kuttab, Sara C. Damewood, Jessica Schmidt, Amber Lin, Kevin Emmerich, Nikolai Schnittke
Journal
Journal of Emergency Medicine, 2024
Conclusions
- Key Predictor: Presence of ≥4 B-lines was significantly associated with care escalation within 12 hours.
- Improved Predictive Power: Combining B-lines with LVF and RV size assessments increased specificity, highlighting its utility in identifying patients who need higher levels of care.
- Clinical Utility: CPUS can assist in rapid stratification of sepsis patients, potentially guiding timely interventions and resource allocation.
Methods
- Study Design: Single-center, prospective, observational study.
- Population: Adult ED patients with suspected sepsis.
- CPUS Variables Assessed:
- Left ventricular systolic function (LVF).
- Right ventricular (RV) size and function.
- Inferior vena cava (IVC) collapsibility.
- Thoracic B-lines.
- Primary Outcome: Composite measure of care escalation within 12 hours of ED presentation, including:
- ICU admission.
- Positive-pressure ventilation.
- Vasopressor infusion.
Results
- Sample: 92 patients enrolled; 18 (19.6%) required care escalation.
- Predictive Findings:
- ≥4 Thoracic B-Lines:
- Odds ratio (OR): 7.8 (95% CI [1.3-26.4], p = 0.002).
- Reduced LVF:
- OR: 4.26 (95% CI [0.06-12.9], p = 0.14).
- Dilated RV Size:
- OR: 2.8 (95% CI [0.4-11.8], p = 0.16).
- Combined Model:
- Area Under Receiver Operating Curve (AUROC): 0.75 (95% CI [0.63-0.88]).
- Abnormality in ≥2 variables:
- Specificity: 95% (Likelihood Ratio [LR+] 6.2).
- Sensitivity: 33% (LR− 0.7).