Acute mortality in critically ill patients undergoing echocardiography with or without an ultrasound contrast agent
Michael L Main1, Mark G Hibberd2, Amy Ryan3
1Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Insights
Ultrasound contrast agents (UCAs) in echocardiography for critically ill patients were associated with lower 48-hour mortality. These findings are reassuring regarding UCA safety in this patient population.
Area of Science:
- Critical Care Medicine
- Cardiology
- Medical Imaging
Background:
- Concerns exist regarding the safety of perflutren-based ultrasound contrast agents (UCAs) in critically ill patients.
- The U.S. Food and Drug Administration has raised safety questions due to rare adverse events linked to UCAs.
Purpose of the Study:
- To compare 48-hour and in-hospital mortality in critically ill patients undergoing echocardiography with or without UCAs.
- To assess the safety and effectiveness of UCAs in echocardiography for critically ill patients.
Main Methods:
- Retrospective observational outcome study using discharge data from Premier, Inc.
- Propensity score-matching was employed to compare mortality between patients who received echocardiography with and without UCAs.
- All-cause 48-hour and hospital stay mortality were the primary outcome measures.
Main Results:
- Patients receiving UCAs had a 48-hour mortality of 1.70% versus 2.50% for non-UCA patients (OR=0.66, 95% CI: 0.54-0.80).
- Hospital stay mortality was lower in the UCA group (14.85%) compared to the non-UCA group (15.66%) (OR=0.89, 95% CI: 0.84-0.96).
Conclusions:
- In propensity-matched critically ill patients, UCA use during echocardiography was associated with a 28% reduction in 48-hour mortality.
- The study provides reassuring evidence on the safety of UCAs in echocardiography for critically ill patients, contrasting with prior concerns.
Objectives:
The objective of this observational study was to compare 48-h all-cause mortality (as well as hospital stay mortality) among critically ill patients who underwent echocardiography either with or without an ultrasound contrast agent (UCA).
Background:
The safety of perflutren-based UCAs has been questioned by the U.S. Food and Drug Administration (particularly when administered to critically ill patients) following rare reports of deaths or life-threatening adverse reactions that occurred in close temporal relationship to UCA administration.
Methods:
This was a retrospective observational outcome study conducted in critically ill patients to compare all-cause 48-h and hospital stay mortality subsequent to echocardiography procedures performed either with or without a UCA. The study utilized discharge data from a database maintained by Premier, Inc. (Charlotte, North Carolina). Premier's database is the largest U.S. hospital-based, service-level comparative database for quality and outcomes research, and provides detailed resource utilization data along with patients' primary and secondary diagnoses and procedure billing codes. A propensity score-matching algorithm between UCA-enhanced echocardiography patients and non-contrast-enhanced echocardiography patients was utilized to reduce the potential for imbalance in covariates of selected patients in the comparison of mortality between groups.
Results:
Patients undergoing echocardiography with a UCA had lower mortality at 48 h compared with patients undergoing non-contrast-enhanced echocardiography (1.70% vs. 2.50%), with an odds ratio = 0.66 (95% confidence interval [CI]: 0.54 to 0.80). Patients undergoing echocardiography with a UCA had lower hospital stay mortality compared with patients undergoing noncontrast echocardiography (14.85% vs. 15.66%), with an odds ratio = 0.89 (95% CI: 0.84 to 0.96).
Conclusions:
In critically ill, propensity-matched hospitalized patients undergoing echocardiography, use of a UCA is associated with a 28% lower mortality at 48 h in comparison with patients undergoing non-contrast-enhanced echocardiography. These results are reassuring, given previous reports suggesting an association between UCAs and increased mortality in critically ill patients.
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