Incidence and Outcomes of Sepsis-Related Cardiomyopathy: A Prospective Cohort Study

Objective: To determine the incidence, predictive factors, and prognosis of sepsis-related cardiomyopathy. Materials and Methods: The present study was a prospective cohort study that enrolled adult septic shock patients admitted to the ICU of Siriraj Hospital (Bangkok, Thailand) between October 2013 and November 2014. All the patients were treated following the surviving sepsis campaign international guidelines 2012. Transthoracic echocardiography was performed during day 1, and then again during days 3 to 4 after septic shock diagnosis. Sepsis-related cardiopathy was diagnosed in patients who had left ventricular ejection fraction (LVEF) at less than 50%. The primary outcome was hospital mortality. The present study was registered in the Thai Clinical Trials Registry (TCTR20200818004). Results: Of the 75 patients enrolled, 24 (32%) were diagnosed as having sepsis-related cardiomyopathy, and 51 sepsis with preserved LVEF. Six of the 51 patients (11.8%) in the sepsis with preserved LVEF group, and nine of the 24 patients (37.5%) in the sepsis-related cardiomyopathy group died in the hospital (p=0.009). Multivariate analysis identified a maximum vasopressor dosage greater than 0.08 mcg/kg/minute and requiring renal replacement therapy as predictive factors associated with sepsis-related cardiomyopathy, while cirrhosis was identified as a protective factor. Sepsis-related cardiomyopathy, pneumonia, and requiring vasopressor were predictive factors associated with hospital mortality, while achieving tissue perfusion goals within six hours after resuscitation was a protective factor against in-hospital death. Conclusion: Sepsis-related cardiomyopathy was identified as a significant type of organ dysfunction among the present study sepsis or septic shock patients, and the mortality rate was high. Keywords: Incidence, Outcomes, Sepsis-related cardiomyopathy

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The Association Between Dynamic Changes in Serum Presepsin Levels and Mortality in Immunocompromised Patients with Sepsis: A Prospective Cohort Study

10.21203/rs.3.rs-115066/v1 ◽

2020 ◽

Author(s):

Jongmin Lee ◽

Seo Hyun Kim ◽

Kyung Hoon Kim ◽

Na Ri Jeong ◽

Seok Chan Kim ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Hospital Mortality ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Area Under The Curve ◽

Immunocompromised Patients ◽

Dynamic Changes ◽

Saps 3 ◽

Sepsis And Septic Shock

Abstract Background: Presepsin is a subtype of soluble CD14 that is increased in the blood of septic patients. We investigated the role of dynamic changes in serum presepsin levels in critically ill, immunocompromised patients with sepsis.Methods: This is a prospective cohort study that included 119 adult patients who were admitted to the intensive care unit (ICU) between March 2019 and June 2020. Sepsis and septic shock were defined as Sepsis-3. Patients were classified into one of the following diagnostic groups: no sepsis, sepsis, and septic shock. Presepsin level was measured on day 1 and day 3 after ICU admission. The primary outcome was in-hospital mortality.Results: Of the 119 patients, sepsis was diagnosed in 40 patients (33.6%) and septic shock was diagnosed in 60 (50.4%) patients. The Simplified Acute Physiology Score (SAPS) 3 and Sequential Organ Failure Assessment score on day 1 were 75.5 ± 14.9 and 9.0 (6.5–11.5), respectively, and the overall hospital mortality was 44.5%. In 61 immunocompromised patients, presepsin levels on day 1 were higher in patients with sepsis than those in patients without sepsis (1203.0 [773.0–2484.0] vs. 753.0 [603.5–1092.0] ng/ml; P = 0.004). The area under the curve (AUC) of presepsin for diagnosing sepsis in immunocompromised patients was 0.87, which was comparable with that of procalcitonin (AUC, 0.892). Presepsin levels on day 3 were higher in patients who died in the hospital than in those who survived (1965.0 [1149.0–3423.0] vs. 933.0 [638.0–1571.0]; P = 0.001). In immunocompromised patients who died in the hospital, presepsin levels on day 3 were significantly higher than those on day 1 (P = 0.018). In the multivariate analysis, ΔPresepsin+ (ΔPresepsin concentrations [day3 – day1] > 0) alone was independently correlated with in-hospital mortality in immunocompromised patients (odds ratio, 6.22; 95% confidence interval, 1.33–29.06; P = 0.020).Conclusion: These findings suggest that dynamic changes in presepsin levels between day 1 and day 3 are associated with in-hospital mortality in patients with sepsis, especially in immunocompromised patients.

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Correlation between NT pro-b-type Natriuretic peptide and left ventricular ejection fraction in children presenting with Dyspnea – a prospective cohort study

Pediatric Review International Journal of Pediatric Research ◽

10.17511/ijpr.2018.i11.04 ◽

2018 ◽

Vol 5 (11) ◽

pp. 569-574

Author(s):

Dr. Aswathy Rajan ◽

◽

Dr. Shriyan Ashvij ◽

Dr. Prem Alva ◽

Dr. Santosh T Soans ◽

...

Keyword(s):

Cohort Study ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Natriuretic Peptide ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

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Left ventricular-arterial coupling as a predictor of stroke volume response to norepinephrine in septic shock – a prospective cohort study

BMC Anesthesiology ◽

10.1186/s12871-021-01276-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoyang Zhou ◽

Jianneng Pan ◽

Yang Wang ◽

Hua Wang ◽

Zhaojun Xu ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Stroke Volume ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Characteristic Curve ◽

Left Ventricular ◽

Arterial Elastance ◽

Tertiary Teaching ◽

Left Ventricular Arterial Coupling

Abstract Background Left ventricular-arterial coupling (VAC), defined as the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees), is a key determinant of cardiovascular performance. This study aims to evaluate whether left VAC can predict stroke volume (SV) response to norepinephrine (NE) in septic shock patients. Methods This was a prospective cohort study conducted in an intensive care unit of a tertiary teaching hospital in China. We recruited septic shock patients who had persistent hypotension despite fluid resuscitation and required NE to maintain mean arterial pressure (MAP) > 65 mmHg. Those patients in whom the target MAP was not reached after NE infusion were ineligible. Echocardiographic variables were measured before (baseline) and after NE infusion. SV responder was defined by a ≥ 15% increase in SV after NE infusion. Results Of 34 septic shock patients included, 19 (56%) were SV responders. Before NE infusion, SV responders had a lower Ees (1.13 ± 0.24 mmHg/mL versus 1.50 ± 0.46 mmHg/mL, P = 0.005) and a higher Ea/Ees ratio (1.47 ± 0.40 versus 1.02 ± 0.30, P = 0.001) than non-responders, and Ea in SV responders was comparable to that in non-responders (1.62 ± 0.36 mmHg/mL versus 1.43 ± 0.28 mmHg/mL, P = 0.092). NE significantly increased Ea and Ees in both groups. The Ea/Ees ratio was normalized by NE administration in SV responders but unchanged in non-responders. The baseline Ea/Ees ratio was positively correlated with NE-induced SV increases (r = 0.688, P < 0.001). Logistic regression analysis indicated that the baseline Ea/Ees ratio was a predictor of SV increases induced by NE (odd ratio 0.008, 95% confidence interval (CI): 0.000 to 0.293), with an area under the receiver operating characteristic curve of 0.816 (95% CI: 0.646 to 0.927). Conclusions The left VAC has the ability to predict SV response to NE infusion in septic shock patients. Trial registration Chinese Clinical Trial Registry, ChiCTR1900024031, Registered 23 June 2019 - Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=40359&htm=4.

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