الفهرس 
Chapter IOnly 14 pages are availabe for public view
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Abstract
Prediction of hospital outcome 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, (P- value=0.002, and r= 0.6).
There was a positive correlation between hs-CRP with PMR (P-value= 0.01
r=0.4). 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).
Key words: TDI, septic shock, mortality, pro BNP, hs CRP, cTnI