Prognostic value of ventricular diastolic dysfunction in patients with severe 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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Faculty Opinions recommendation of Application of updated guidelines on diastolic dysfunction in patients with severe sepsis and septic shock.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732332212.793541045 ◽

2018 ◽

Author(s):

Michael J Lanspa

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Diastolic Dysfunction ◽

Sepsis And Septic Shock

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Application of updated guidelines on diastolic dysfunction in patients with severe sepsis and septic shock

Annals of Intensive Care ◽

10.1186/s13613-017-0342-x ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 11

Author(s):

David J. Clancy ◽

Timothy Scully ◽

Michel Slama ◽

Stephen Huang ◽

Anthony S. McLean ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Diastolic Dysfunction ◽

Sepsis And Septic Shock

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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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Serum Procalcitonin and Procalcitonin Clearance as a Prognostic Biomarker in Patients with Severe Sepsis and Septic Shock

BioMed Research International ◽

10.1155/2016/1758501 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 13

Author(s):

Min-Yi Huang ◽

Chun-Yu Chen ◽

Ju-Huei Chien ◽

Kun-Hsi Wu ◽

Yu-Jun Chang ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Prognostic Value ◽

Prognostic Biomarker ◽

Dynamic Changes ◽

Sepsis Diagnosis ◽

Sepsis And Septic Shock ◽

Overall Mortality

We evaluated the tendency of the plasma concentration and procalcitonin (PCT) clearance (PCTc) to act as biomarkers of prognosis in patients with severe sepsis and septic shock. From 2011 to 2013, we prospectively analyzed patients with sepsis admitted to the intensive care unit (ICU). The serum PCT was evaluated at the time of sepsis diagnosis and again after 48 h (day 3) and 96 h (day 5). PCTc after 48 h (PCTc-day 3) and 96 h (PCTc-day 5) was also calculated to evaluate the prognostic value for survival in patients with sepsis. A total of 48 patients were included. Overall mortality was 16.7% (8 patients). PCTc was higher in survivors than in nonsurvivors, with significant differences on day 3 and day 5 (p=0.033;p=0.002, resp.); however, serum PCT levels on day 1, day 3, and day 5 were not significant prognostic factors for survival. The prognosis of patients with severe sepsis and septic shock may be associated with PCTc. Dynamic changes of PCT reflected as PCTc at 48 h (day 3) and 96 h (day 5) after admission to the ICU may serve as a predictor of survival in critically ill patients with severe sepsis.

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