Left atrial function for outcome prediction in severe sepsis and septic shock: An echocardiographic study

Abstract

Left ventricular function and B-type natriuretic peptide (BNP) assessments are used to predict mortality in septic patients. Left atrial function has never been used to prognosticate outcome in septic patients.Objectives:To assess if deterioration of left atrial function in patients with severe sepsis and septic shock could predict mortality.Methods:We studied 30 patients with severe sepsis or septic shock with a mean age of 49.8±16.17. Echocardiographic parameters were measured on admission, Day 4, and Day 7, which comprised left ventricular ejection fraction (EF), and atrial function that is expressed as atrial ejection force (AEF). All patients were subjected to BNP assay as well. Multivariate analyses adjusted for APACHE II score was used for mortality prediction.Results:The underlying source for sepsis was lung in 10 patients (33%), blood in 7 patients (23.3%), abdomen in 7 patients (23.7%), and 3 patients (10%) had UTI as a cause of sepsis. Only one patient had CNS infection. In-hospital mortality was 23.3% (7 patients). Admission EF showed a significant difference between survivors and non survivors, 49.01±6.51 vs.. 56.44±6.93% (P<0.01). On the other hand, admission AEF showed insignificant changes between the same groups, 10.9±2.81 vs. 9.41±2.4 k/dynes P=0.21, while BNP was significantly higher in the non survivors, 1123±236.08 vs. 592.7±347.1 pg/ml (P<0.001). The predicatable variables for mortality was Acute Physiology and Chronic Health Evaluation II score, BNP, then EF.Conclusion:In septic patients, left atrial function unlike the ventricular function and BNP levels can not be used as an independent predictor of mortality.

Relation of Echocardiographic Parameters to Outcome of Patients with Severe Sepsis and Septic Shock

“…TTE diagnostic variables have been shown to be predictive of mortality in non-critical care cardiovascular patients with diastolic dysfunction. 11 Landesberg G et al (2015) Studied 105 patients with sepsis and found that, N-terminal pro-B-type natriuretic peptide (NT-pro BNP) strongly correlated with both reduced LVEF and reduced e′-wave velocity, and hs-troponin-T correlated mainly with reduced e'wave with severe sepsis and septic shock. In present study because of resource limitations we have not included cytokines and biomarkers, but there was strong correlation between diastolic dysfunction and mortality in patients with septic shock.…”

Focused rapid echocardiographic evaluation versus vascular cather-based assessment of cardiac output and function in critically ill trauma patients

“…However, if this is not true, critical dysfunction may go undetected, and increased mortality in both trauma and septic patients with systolic failure has been observed. 4,5 A depressed EF can also directly impact fluid management and the use of inotrophic agents in the ICU.…”