Cardiovascular Factors Associated with Septic Shock Mortality Risks

Abstract

The presence of at least one underlying chronic health condition, such as long-term care facility residence, malnutrition, immunosuppression, or prosthetic device use, are well known factors increasing infection risks and progression to severe sepsis. Furthermore, some degree of cardiovascular dysfunction occurs in the majority of septic patients and this prognostic significance has become increasingly recognized. Since septic shock carries the highest mortality risk on the sepsis spectrum, it is important to evaluate the cardiovascular risk impact on mortality in this subset of patients. METHODS METHODS The retrospective parent study contributing these electronic health record data was IRB approved and conducted across four hospital intensive care units within the authors' Michigan healthcare system. Patients with cardiopulmonary arrest or transfers from an outside facility were excluded. The authors evaluated the presence of modifiable and non-modifiable cardiovascular risk factors in septic shock patients upon admission to an emergency department. RESULTS RESULTS The authors' final analytic sample included n = 109 adults who were discharged alive compared to those who died during hospitalization. Those patients who died were more often male with an underlying history of hypertension, congestive heart failure, coronary artery disease, or peripheral arterial diseases, were taking pre-admission beta-blocker medications, and had higher APACHE II scores at admission compared to the patients who survived to discharge. Significantly higher mortality risks were found in sample patients with increased troponin levels on admission and atrial fibrillation. CONCLUSIONS CONCLUSIONS Appropriate triage and prompt treatment of these patient groups with tailored therapy to stabilize and improve cardiac dysfunction in the emergency department could potentially lead to improved survival outcomes. Clinicians need more studies to determine therapeutic targets most impacting underlying pathophysiologic mechanisms such as elevated troponin and atrial fibrillation that greatly increase mortality risks.

Impact of heart failure on outcomes in patients with sepsis: A systematic review and meta-analysis

“…After searching the electronic databases, 18001 publications were retrieved. Following thorough examination according to the inclusion and exclusion criteria, 10 studies (35712 patients in total) published between 2012 and 2021 were finally included in the meta-analysis[ 4 , 6 , 9 , 11 , 12 , 19 - 23 ]. A PRISMA flow chart of the study is presented in Figure 1 .…”

“…The main characteristics of the included studies are reported in Table 1 . Of the ten included studies, five studies were conducted in the United States[ 4 , 6 , 11 , 12 , 22 ] and the remaining five studies were from the Republic of China[ 9 ], Macedonia[ 19 ], France[ 20 ], Israel[ 21 ] and Japan[ 23 ]. Three of the studies were prospective studies[ 4 , 19 , 20 ] and the other seven were retrospective studies[ 6 , 9 , 11 , 12 , 21 - 23 ].…”

“…Sepsis and heart failure (HF) are common complications in critically ill patients and cause additional complex pathological conditions[ 5 , 6 ]. Studies have shown that sepsis and HF have the highest 30-day readmission rates among medical insurance patients[ 7 ].…”

Effect of Premorbid Beta-Blockers on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis

“…All the studies reported short-term mortality (Figure 2). 9,10,15,[19][20][21][22][23][24][25] The pooled OR of short-term mortality associated with the premorbid use of beta-blockers was 0.85 (95% CI, 0.69-1.04; P = .12, I 2 = 50%). Five studies reported an adjusted OR of short-term mortality; the pooled adjusted OR of short-term mortality associated with the premorbid use of beta-blockers was 0.73 (95% CI, 0.65-0.83; P < .001, I 2 = 0%).…”

“…10,20,22,25 There were no significant differences in the ICU LOS (SMD, 0.05; 95% CI, −0.07-0.18; P = .38; I 2 = 68%) and need for mechanical ventilation (OR, 1.14; 95% CI, 0.69-1.90; P = .61; I 2 = 80%). Five studies reported the HR on admission 9,21,[23][24][25] and lactate levels on admission. 9,10,20,23,24 HR on admission (SMD, −0.33; 95% CI, −0.50-0.16; P < .001; I 2 = 66%) and lactate level on admission (SMD, −0.25; 95% CI, −0.36-0.13; P < .001; I 2 = 49%.)…”