Echocardiographic Assessment of Left Ventricular Systolic and Diastolic Functions in Dogs with Severe Sepsis and Septic Shock; Longitudinal Study

The purpose of this study was to monitor left ventricular systolic dysfunction (LVSD) and diastolic dysfunction (LVDD) using transthoracic echocardiography (TTE) in dogs with severe sepsis and septic shock (SS/SS). A prospective longitudinal study using 23 dogs with SS/SS (experimental group) and 20 healthy dogs (control group) were carried out. All the clinical, laboratory and cardiologic examinations for the experimental dogs were performed at admission, 6 and 24 h after the start of treatment and on the day of discharge. LVSD was described as LV ejection fraction (LVEF) < 50%. LVDD was determined when the septal mitral annulus early diastolic velocity (LVEm) was <8 cm/s. LVSD and LVDD were present in 3 and 16 dogs with SS/SS, respectively, with both types of dysfunction present in 2 of the dogs. Although all the dogs with LVSD survived, 8 dogs with LVDD did not. The survival period was significantly shorter in dogs with an LVEm < 8 cm/s (1.3 ± 1.4 days). In conclusion, LVDD, rather than LVSD, was a common cardiovascular abnormality in the septic dogs, and this may be a negative prognostic factor. TTE is a useful tool for the identifying and monitoring of myocardial dysfunction in the dogs with SS/SS.

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Prognostic importance of tissue Doppler imaging of systolic and diastolic functions in dogs with severe sepsis and septic shock

Acta Veterinaria Hungarica ◽

10.1556/004.2019.051 ◽

2019 ◽

Vol 67 (4) ◽

pp. 517-528

Author(s):

Mehmet Ege Ince ◽

Kursad Turgut ◽

Aybars Akar ◽

Amir Naseri ◽

Ismail Sen ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Diastolic Dysfunction ◽

Sensitivity And Specificity ◽

Mitral Annulus ◽

Tissue Doppler ◽

Left Ventricular ◽

Doppler Imaging ◽

Control Group ◽

Sepsis And Septic Shock

The goal of this study was to determine the distribution of left ventricular (LV) systolic and diastolic dysfunctions and their prognostic value in canine parvovirus-infected dogs suffering from severe sepsis and septic shock (SS/SS). Twenty dogs with SS/SS (experimental group) and 18 healthy dogs (control group) were used in the study. Systolic and diastolic dysfunction was present in three (15%) and 14 (70%) diseased dogs, respectively, with both types of dysfunction present in two (10%) of the patients. These dogs were split into two groups: survivors (Sv, n = 14) and non-survivors (non-Sv, n = 6). The pulsed wave tissue Doppler (PW-TDI) septal mitral annulus systolic velocity (LVS'), an index of systolic dysfunction, had a high sensitivity and specificity to differentiate Sv and non-Sv animals, with values of 83.3% (95% CI: 41.6–98.4) and 83.3% (95% CI: 59.8–94.8), respectively, at an optimum cut-off point of ≥ 9.90. The PW-TDI septal early mitral annulus early-diastolic peak velocity (E'), an index of diastolic dysfunction, had the best sensitivity and specificity to differentiate Sv and non-Sv dogs, with values of 100% (95% CI: 55.2–100) and 100% (95% CI: 78.9–100), respectively, at an optimum cut-off point of ≤ 6.50. Therefore, diastolic dysfunction determined by E' is a good independent outcome predictor.

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Clinical Outcomes of Severe Sepsis and Septic Shock Patients with Left Ventricular Dysfunction Undergoing Continuous Renal Replacement Therapy: A Multicenter Retrospective Study

10.21203/rs.3.rs-129360/v1 ◽

2020 ◽

Author(s):

Guangwei Yu ◽

Kun Cheng ◽

Qing Liu ◽

Zhenhao Zhu ◽

Fenghui Lin ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Retrospective Study ◽

Renal Replacement Therapy ◽

Left Ventricular ◽

Control Group ◽

Early Group ◽

Icu Mortality ◽

Lv Dysfunction ◽

Sepsis And Septic Shock

Abstract Background: Baseline left ventricular (LV) dysfunction is associated with subsequent risks of acute kidney injury (AKI) and mortality in patients with sepsis. This study investigated the therapeutic effects of continuous renal replacement therapy (CRRT) in hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction.Methods: In this multicenter retrospective study, severe sepsis and septic shock patients with LV dysfunction were classified into one of two groups according to the timing of CRRT: the early group (before AKI was detected) or the control group (patients with AKI). All-cause intensive care unit (ICU) mortality and ICU stay were compared between the groups. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics.Results: After sIPTW analysis, the ICU mortality was significantly lower in the early group than the control group (25.9% vs 59.0%, p < 0.001). Weighted multivariable analysis showed that early CRRT initiation was a protective factor for the risk of ICU mortality. Early CRRT initiation significantly improved the ICU mortality compared to the control group (OR, 0.322; 95% CI, 0.125-0.834; p = 0.020).Conclusions: Early CRRT in the absence of AKI is suggested for hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction since it benefits survival outcomes.Trial registration: The study was preregistered in the Chinese Clinical Trial Registry (number, ChiCTR2000033083).

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Is Presepsin a Reliable Marker of Sepsis Diagnosis in Pediatric Intensive Care Unit?

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3431 ◽

2020 ◽

Vol 8 (B) ◽

pp. 66-70

Author(s):

Hebat-Allah Algebaly ◽

Hala M. Fouad ◽

Maha M. Elkholy ◽

Sally K. Ibrahim ◽

Nermin M. Riad

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Consensus Conference ◽

University Teaching ◽

Control Group ◽

Healthy Children ◽

International Consensus ◽

Critical Patients ◽

Sepsis And Septic Shock

BACKGROUND: Sepsis is a major challenge in emergency departments and intensive care units (ICUs). Sepsis also mimics or interacts with many other disorders causing high mortality and morbidity. There is no accurate biomarker or test to diagnose or predict sepsis. The treatment of sepsis is often based on the clinician’s experience. AIM: We conducted this study to analyze the serum level of presepsin in pediatric critical patients with SIRS, sepsis, severe sepsis, and septic shock. METHODS: The study included 58 children, 32 septic pediatric patients admitted to the Pediatric ICU (PICU) of Cairo University Teaching Hospital and 26 healthy children who served as a control group. The aim was to estimate the diagnostic accuracy of presepsin in predicting sepsis in PICU. We classified the patients into systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock according to the international consensus conference criteria. RESULTS: In our study, we detected a positive correlation between C-reactive protein and presepsin levels at day 1 and day 3 of admission and a negative correlation between hemoglobin and presepsin levels at day 1. However, we found no difference in the serum presepsin between the children who had sepsis and the healthy ones (at day 1 [p = 0.430) and at day 3 [p = 0.845]). We also found that serum levels of presepsin were not significantly increased with the increasing severity of sepsis despite the higher median values with increasing sepsis severity. CONCLUSIONS: It was noted that presepsin levels increased in anemic critical patients, whereas presepsin had no role in differentiating the septic critical patients from healthy children. However, its level increased with increasing severity of sepsis grade.

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Evaluation of red cell distribution width (RDW) as a septic marker in comparison with clinical scores and C-reactive protein

QJM ◽

10.1093/qjmed/hcab086.014 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ali Ahmed Naga ◽

Mohammed Ismaeil Abdel Fattah ◽

Walid Hamed Nofal ◽

Mohammed Abd-elsalam AlMenshawe

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Distribution Width ◽

Clinical Scores ◽

Group I ◽

Significant Difference ◽

Sepsis And Septic Shock

Abstract Background Challenges of diagnosing and treating sepsis only seem more difficult as incidence increases, patients become older and sicker, and pathogenic organisms evolve. New understanding of inflammatory mediators and pathways, immunity, and genetic variability in this disease state suggests that the current definitions of SIRS, sepsis, severe sepsis, and septic shock are oversimplified. Objective The aim of our study is to evaluate the level of RDW, CRP and clinical scores "SOFA and APACHI" as markers in patients with sepsis and their levels on the outcome and resolution of sepsis in ICU. Methodology We conducted a prospective observational controlled study on 90 adult persons of both sex, 45 of them are adult patients and served as the study group (Group I), and the other 45 are healthy adult volunteers and served as the control group (Group II). The study group represented patients admitted to the ICU of Intensive Care Unit at Damanhour Medical National Institute who fulfilled the diagnostic criteria for sepsis, severe sepsis and septic shock on arrival to ICU according to the SCCM/ ESICM/ ACCP/ ATS/SIS International Sepsis Definitions Conference. Results. In the present study we found that CRP measured on admission was not a predictor of mortality, while that measured at day 5 and day 10 predicted mortality, where there was no statistically significant difference in CRP levels between survivors and non-survivors at the day of admission while there were statistically significant differences between survivors and non survivors according to CRP levels at day 5 (p = 0.001*) and at day 10 (p = 0.001*). It was found also that there were statistically significant differences between survivors and non-survivors according to RDW at day 1(p = 0.011*) and at day 5(p = 0.009*), at day 10 was found there was no statistically significant difference between survivors and non-survivors (p = 0.338). Conclusion RDW is a new promising cheap and readily available biomarker that can be able to diagnose patients with sepsis with accuracy comparable to CRP. Also, RDW at admission is able to predict mortality.

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Right-to-left ventricular end diastolic diameter ratio in severe sepsis and septic shock

Journal of Critical Care ◽

10.1016/j.jcrc.2019.04.008 ◽

2020 ◽

Vol 58 ◽

pp. 113

Author(s):

A. Úbeda-Iglesias ◽

I. Fernández-Burgos ◽

L. Alonso-Romero

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Left Ventricular ◽

Diameter Ratio ◽

Sepsis And Septic Shock

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Clinical Spectrum, Frequency, and Significance of Myocardial Dysfunction in Severe Sepsis and Septic Shock

Mayo Clinic Proceedings ◽

10.1016/j.mayocp.2012.01.018 ◽

2012 ◽

Vol 87 (7) ◽

pp. 620-628 ◽

Cited By ~ 139

Author(s):

Juan N. Pulido ◽

Bekele Afessa ◽

Mitsuru Masaki ◽

Toshinori Yuasa ◽

Shane Gillespie ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Myocardial Dysfunction ◽

Clinical Spectrum ◽

Sepsis And Septic Shock

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Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066616684774 ◽

2016 ◽

Vol 33 (12) ◽

pp. 680-686 ◽

Cited By ~ 2

Author(s):

Saraschandra Vallabhajosyula ◽

Shane M. Gillespie ◽

David W. Barbara ◽

Nandan S. Anavekar ◽

Juan N. Pulido

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Hospital Mortality ◽

Diastolic Dysfunction ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Secondary Outcomes ◽

Sepsis And Septic Shock

Background: Left ventricular systolic dysfunction (LVSD) and LV diastolic dysfunction (LVDD) are commonly seen in severe sepsis and septic shock; however, their role in patients with concurrent invasive mechanical ventilation (IMV) is less well defined. Methods: This was a prospective observational study on all patients admitted to all the intensive care units (ICUs) at Mayo Clinic, Rochester from August 2007 to January 2009. All adult patients with severe sepsis and septic shock and concurrent IMV without prior heart failure underwent transthoracic echocardiography within 24 hours. Patients with active pregnancy, prior congenital or valvular heart disease, and prosthetic cardiac valves were excluded. Left ventricular systolic dysfunction was defined as LV ejection fraction (LVEF) <50% and LVDD as E/e′ >15. Primary outcome was hospital mortality, and secondary outcomes included IMV duration, ICU length of stay (LOS), and total LOS. Two-tailed P value of <.05 was considered statistically significant. Results: In a total of 106 patients, 58 (54.7%) met our inclusion criteria, with 17 (29.3%), 11 (19.0%), and 5 (8.6%) having LVSD, LVDD, and both, respectively. The cohorts with and without LVSD and LVDD did not differ significantly in their baseline characteristics and laboratory and ventilatory parameters. Compared to those without LVSD, patients with LVSD had higher LV end-systolic diameters but were not different in their left atrial diameters or E/e′ ratio. Patients with LVDD had a higher E velocity and E/e′ ratio compared to those without LVDD. Hospital mortality was not different in patients with and without LVSD (8 [47%] vs 21 [51%], P = 1.00) and LVDD (8 [73%] vs 21 [45%], P = .18). Secondary outcomes were not different between the 2 groups. Conclusion: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.

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Echocardiography for left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index as a predictor to fluid responsiveness in severe sepsis

QJM ◽

10.1093/qjmed/hcaa039.032 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

D A M Nasr ◽

A A Moharam ◽

M M K Abdallah ◽

A A S M Karam

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Fluid Responsiveness ◽

Host Response ◽

Vena Cava ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Collapsibility Index ◽

Left Ventricular Outflow ◽

Sepsis And Septic Shock

Abstract Background Severe sepsis is the most common cause of death for patients admitted to the critical care units. Sepsis is a multifaceted host response to an infecting pathogen that may be significantly amplified by endogenous factors. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This emphasizes the primacy of the non-homeostatic host-response to infection, the potential lethality that is considerably in excess of a straightforward infection, and the need for urgent recognition. Aims The aim of this work is to compare Left ventricular Outflow Tract (LVOT) velocity time Integral (VTI) and inferior Vena Cava (IVC) collapsibility index as a predictor to fluid responsiveness in patients with severe sepsis and septic shock. Methodology This study was conducted on 40 patients of both sex who were admitted to the intensive care unit were diagnosed as severe sepsis and /or septic shock. Patients were divided in two groups: Responders (R): 22 patients with LVOT ΔVTI 500 ≥ 15%. Non-responders (NR): 18 patients with LVOT ΔVTI 500 < 15%. Results Our results showed that IVCCI 100 and 500 were a less reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock than ΔVTI 500. However when using IVCCI after 100 or 500 cc of fluid resuscitation, patients with IVCCI 100 above 38% or IVCCI 500 above 30% are more likely to respond to fluid challenge. More precisely, an IVCCI 100 below 38% and IVCCI 500 value below 30% cannot exclude fluid responsiveness. Conclusions IVC collapsibility Index is less reliable predictor than VTI (LVOT) in predicting fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and/ or septic shock Recommendations IVCCI should be used more cautiously as a predictor to fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and /or septic shock.

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Effects of Safflower Yellow on the Treatment of Severe Sepsis and Septic Shock: A Randomized Controlled Clinical Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/3948795 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Xiao-jin Li ◽

Ru-rong Wang ◽

Yan Kang ◽

Jin Liu ◽

Yun-xia Zuo ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Survival Curve ◽

Control Group ◽

Controlled Clinical Trial ◽

Study Group ◽

Kaplan Meier ◽

New Strategy ◽

Lactate Levels ◽

Sepsis And Septic Shock

Objective.To evaluate the clinical effect of safflower yellow on the treatment of severe sepsis and septic shock.Methods.85 patients with severe sepsis and septic shock were randomly selected to receive either therapy according to the international guidelines for management of severe sepsis and septic shock (Surviving Sepsis Campaign 2012) (control group,n= 45) or conventional therapy plus safflower yellow (study group,n= 40). The 28-day mortality and 28-day Kaplan-Meier survival curves were compared as primary outcomes.Results.The 28-day mortality from all causes and in-hospital mortality were significantly lower in the study group (50%, 17.5%) as compared to the control group (78.58%, 54.76%) (P= 0.007, all causes,P< 0.001, in-hospital), and the 28-day Kaplan-Meier survival curve was higher in the study group than in the control group (P= 0.008, all causes,P< 0.001, in-hospital, Log Rank). 72 hours after treatment, secondary outcomes including heart rate, leukocyte counts, lactate levels, and platelet counts of patients in the study group were ameliorated significantly as compared with the control group.Conclusion.This study offers a potential new strategy employing safflower yellow to more effectively treat patients with severe sepsis and septic shock. This trial is registered with identifierChiCTR-TRC-14005196.

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Association between left ventricular diastolic dysfunction and septic acute kidney injury in severe sepsis and septic shock: A multicenter retrospective study

Perfusion ◽

10.1177/0267659121988969 ◽

2021 ◽

pp. 026765912198896

Author(s):

Guangwei Yu ◽

Kun Cheng ◽

Qing Liu ◽

Xiaohong Lin ◽

Fenghui Lin ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Severe Sepsis ◽

Retrospective Study ◽

Kidney Injury ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Septic Acute Kidney Injury ◽

Ventricular Diastolic Dysfunction ◽

Sepsis And Septic Shock

Introduction: Left ventricular diastolic dysfunction (LVDD) adversely impacts renal function, and E/e′ is a significant predictor of adverse kidney events under different clinical conditions. However, no studies have evaluated the association between LVDD and septic acute kidney injury (AKI) among patients with severe sepsis and septic shock. Methods: This multicenter retrospective study evaluated adult patients with severe sepsis or septic shock between January 1, 2013, and December 31, 2019, who underwent echocardiography within 24 hours after admission to an intensive care unit. Results: A total of 495 adult patients were enrolled in the study. LVDD grades II and III were associated with severe (stage 3) AKI ( p < 0.001, p for trend < 0.001). E/e′ and e′ were risk factors for septic AKI (OR, 1.155; 95% CI, 1.088–1.226, p < 0.001; and OR, 7.218; 95% CI, 2.942–17.712, p < 0.001, respectively) in the multivariate logistic regression analysis. The area under the receiver operating characteristic curve of E/e′ and e′ was 0.728 (95% CI, 0.680–0.777, p < 0.001) and 0.715 (95% CI, 0.665–0.764, p < 0.001), respectively. Conclusions: LVDD was associated with septic AKI, and E/e′ and e′ are useful predictors of septic AKI among patients with severe sepsis or septic shock. Trial registration The study was registered at the Chinese Clinical Trial Registry (Protocol No. ChiCTR2000033083).

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