Is Left Ventricular Systolic Dysfunction Associated With Increased Mortality Among Patients With Sepsis and Septic Shock?

Dugar, Siddharth; Sato, Ryota; Chawla, Sanchit; Young, J. Gerald; Grimm, Richard A.; Collier, Patrick; Lanspa, Michael J.; Duggal, Abhijit

doi:10.1016/j.chest.2023.01.010

Cited by 27 publications

(20 citation statements)

References 43 publications

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“…In fact, a meta-analysis suggested that venoarterial ECMO has very poor outcomes in septic shock without severe left ventricular dysfunction (21) while it did not in those with severe left ventricular dysfunction (21). This is contrary to our recent study showing significantly worse mortality in septic patients with left ventricular ejection fraction <25% (22). These results suggest that in sepsis-associated cardiogenic shock, correct patient selection for venoarterial ECMO as guided by PAC findings may significantly impact their outcomes.…”

Section: Discussioncontrasting

confidence: 99%

Invasive Hemodynamic Monitoring With Pulmonary Artery Catheter in Sepsis-Associated Cardiogenic Shock

Sato,

Hasegawa,

Guo

et al. 2023

Shock

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Background Both sepsis-induced cardiomyopathy and worsening of pre-existing cardiac disease can contribute to circulatory shock in septic patients, The early use of pulmonary artery catheter (PAC) could play a pivotal role in the management of sepsis-associated cardiogenic shock. In this study, we aimed to evaluate the impact of early invasive hemodynamic monitoring with PAC in patients with sepsis-associated cardiogenic shock. Method We performed a retrospective study using the National Inpatient Sample data from 01/2017 to 12/2019. The early use of PAC was defined as the use of PAC within 2 days from the admission. We performed the multivariable logistic regression analysis to investigate the association between the early use of PAC and in-hospital mortality in patients with sepsis-associated cardiogenic shock and sepsis without cardiogenic shock, respectively. Results There was no difference in in-hospital mortality between PAC and No PAC groups in sepsis without cardiogenic shock (adjusted odds ratio [aOR]: 1.05, 95% confidence interval [CI]: 0.82 – 1.35, p = 691). On the other hand, the early use of PAC was independently associated with lower in-hospital mortality in patients with sepsis-associated cardiogenic shock (aOR: 0.58, 95% confidence interval [CI]: 0.46 – 0.72, p < 0.001). The use of PAC was also associated with increased use of MCS in those with sepsis-associated cardiogenic shock (aOR: 12.26, 95% CI: 9.37 – 16.03, p < 0.001). For patients with sepsis-associated cardiogenic shock, the use of PAC after 2 days of admission was associated with significantly higher in-hospital mortality and decreased use of mechanical circulatory support. Conclusion The use of pulmonary artery catheters in sepsis-associated cardiogenic shock was associated with significantly lower in-hospital mortality and increased use of mechanical circulatory supports in patients with sepsis-associated cardiogenic shock.

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Section: Discussioncontrasting

confidence: 99%

Invasive Hemodynamic Monitoring With Pulmonary Artery Catheter in Sepsis-Associated Cardiogenic Shock

Sato,

Hasegawa,

Guo

et al. 2023

Shock

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“…This nding is further supported by the negative correlation between LVEF and vascular resistance in these patients. We also found that the relationship between LVEF and in-hospital mortality was linear in cirrhotic patients with sepsis, while previous work from our group has shown U-shaped curve in non-cirrhotic patients with sepsis (19).…”

Section: Discussionsupporting

confidence: 58%

Echocardiographic Profile of Cirrhotic Patients with Sepsis and Septic Shock: A Propensity Score Matched Case-Control Study

You,

Sato,

Chawla

et al. 2023

Preprint

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Background Our understanding of changes in hemodynamics in cirrhotic patients with sepsis and septic shock and its impact on outcomes remains limited. Our study aims to investigate differences in hemodynamic profiles using echocardiography between septic patients with and without cirrhosis. Methods This is a single-center, retrospective study of septic patients with echocardiogram within 3 days of a medical intensive care unit (MICU) admission. We compared baseline characteristics, echocardiographic parameters, and outcomes between patients with and without cirrhosis. A propensity score-matched case-control model was developed to describe the differences in hemodynamic parameters between the groups. Results 3,151 patients with sepsis and septic shock were included of which 421 (13%) had cirrhosis. In the propensity score model, cirrhotic patients had significantly higher left ventricular ejection fraction (63.4 vs. 56.2%, p < 0.001) and stroke volume (73.3 vs. 52.0 ml, p < 0.001) along with lower arterial elastance (Ea) (1.31 vs. 1.82, p < 0.001) and systemic vascular resistance (SVR) (1,110 vs. 1,370 dynes/sec/m− 5, p = 0.001). There was no difference between left ventricular elastance (Ees) (0.99 vs. 1.09, p = 0.107) and ventricular-arterial coupling (Ea/Ees) (1.29 vs. 1.40, p = 0.061). Conclusion Septic patients with cirrhosis had higher LVEF with a significantly higher percentage of hyperdynamic state than those without cirrhosis. Lower Ea and SVR without significant differences in Ees and Ea/Ees suggest vasodilation as the principal driver of the hyperdynamic profile in cirrhosis. This finding may facilitate tailored hemodynamic management focused on restoring vascular tone in cirrhotic septic patients.

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“…However, this is a controversial matter since a recent retrospective study conducted on over 3,000 patients showed a U-shape association between LV ejection fraction (EF) and in-hospital mortality in septic patients; indeed, both severe systolic dysfunction (LVEF < 25%) and hyperdynamic conditions (LVEF ≥70%) were independently associated with higher mortality. 10 Hence, the latter study confirms the poor outcomes of patients with severe LV systolic dysfunction but also highlights the impact of a hyperdynamic profile. Further, metanalyses conducted so far have not shown an association between LVEF and mortality in sepsis.…”

Section: Myocardial Dysfunction In Icu-systolic Dysfunctionsupporting

confidence: 56%

“…Hence, as it can be observed, the highest mortality was reported in those with LV systolic dysfunction, followed by RV failure and persistent hypovolemia, while the LV hyperkinetic profile did not seem associated with an increase in mortality. However, this is a controversial matter since a recent retrospective study conducted on over 3,000 patients showed a U‐shape association between LV ejection fraction (EF) and in‐hospital mortality in septic patients; indeed, both severe systolic dysfunction (LVEF < 25%) and hyperdynamic conditions (LVEF ≥70%) were independently associated with higher mortality 10 . Hence, the latter study confirms the poor outcomes of patients with severe LV systolic dysfunction but also highlights the impact of a hyperdynamic profile.…”

Section: Myocardial Dysfunction In Icu–systolic Dysfunctionmentioning

confidence: 99%

Diastology in the intensive care unit: Challenges for the assessment and future directions

Gonzalez,

Santonocito,

Maybauer

et al. 2024

Echocardiography

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Myocardial dysfunction is common in patients admitted to the intensive care unit (ICU). Septic disease frequently results in cardiac dysfunction, and sepsis represents the most common cause of admission and death in the ICU. The association between left ventricular (LV) systolic dysfunction and mortality is not clear for critically ill patients. Conversely, LV diastolic dysfunction (DD) seems increasingly recognized as a factor associated with poor outcomes, not only in sepsis but also more generally in critically ill patients. Despite recent attempts to simplify the diagnosis and grading of DD, this remains relatively complex, with the need to use several echocardiographic parameters. Furthermore, the current guidelines have several intrinsic limitations when applied to the ICU setting. In this manuscript, we discuss the challenges in DD classification when applied to critically ill patients, the importance of left atrial pressure estimates for the management of patients in ICU, and whether the study of cardiac dysfunction spectrum during critical illness may benefit from the integration of left ventricular and left atrial strain data to improve diagnostic accuracy and implications for the treatment and prognosis.

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Is Left Ventricular Systolic Dysfunction Associated With Increased Mortality Among Patients With Sepsis and Septic Shock?

Cited by 27 publications

References 43 publications

Invasive Hemodynamic Monitoring With Pulmonary Artery Catheter in Sepsis-Associated Cardiogenic Shock

Invasive Hemodynamic Monitoring With Pulmonary Artery Catheter in Sepsis-Associated Cardiogenic Shock

Echocardiographic Profile of Cirrhotic Patients with Sepsis and Septic Shock: A Propensity Score Matched Case-Control Study

Diastology in the intensive care unit: Challenges for the assessment and future directions

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