Utilization of Echocardiography After Acute Kidney Injury Was Associated with Improved Outcomes in Patients in Intensive Care Unit

Yugang Hu,* Jia Zhou,* Quan Cao, Hao Wang, Yuanting Yang, Ye Xiong, Qing Zhou Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qing ZhouDepartment of Ultrasound Imaging, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, People’s Republic of ChinaTel +86027-88041911Email qingzhou@whu.edu.cnBackground: We aimed to investigate the association between usage of transthoracic echocardiography (TTE) within 24 hours after acute kidney injury (AKI) and the prognosis of patients in intensive care unit (ICU).Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) database was used to identify AKI patients with and without TTE administration. The primary outcome was 28-day mortality. Multivariable regression was used to clarify the association between TTE and clinical outcomes and propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized to validate our findings.Results: Among 23,945 eligible AKI patients, 3361 patients who received TTE and 3361 who did not conduct TTE had similar propensity scores which were included in this study. After matching, the TTE group had a significantly lower 28-day mortality (OR 0.80, 95% CI 0.72– 0.88, P< 0.001). Patients in the TTE group received more fluid on day 1 and day 2 and had a more urine volume on day 1 and day 3, and the reduction in serum creatinine was greater than that in the no TTE group. The mediating effect of creatinine reduction was remarkable for the whole cohort (P=0.02 for the average causal mediation effect).Conclusion: TTE utilization was associated with decreased risk-adjusted 28-day mortality for AKI patients in ICU and was proportionally mediated through creatinine reduction.Keywords: echocardiography, acute kidney injury, medical information mart for intensive care, propensity score matching, mortality