Prognosis of Left Ventricular Systolic Dysfunction in Septic Shock Patients

Prabhu, Mukhyaprana; Yalakala, Suresh Kumar; Shetty, Ranjan; Thakkar, Ashok; Sitapara, Tulsee

doi:10.7860/jcdr/2015/10812.5640

Cited by 13 publications

(16 citation statements)

References 27 publications

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“…Our observation that peripheral edema was paradoxically associated with a lower risk of AKI in patients with iLVD likely reflects a component of selection bias, since volume overload is an indication for ICU admission that is readily treatable and is in keeping with the complex epidemiology between left ventricular function and outcome. 28 , 29 , 30 Because our study was limited to critically ill patients, the applicability of our findings to a broader context is uncertain. The indication for performing echocardiography was not known, potentially introducing selection bias into our analyses.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness

Chen

Lee

Johnson

et al. 2017

Kidney International Reports

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IntroductionThe cardiorenal syndrome generally focuses on left ventricular function, and the importance of the right ventricle as a determinant of renal function is described less frequently. In a cohort of critically ill patients with echocardiographic measurements obtained within 24 hours of admission to the intensive care unit, we examined the association of right ventricular function with acute kidney injury (AKI) and AKI-associated mortality. We also examined whether clinical measurement of volume overload modified the association between ventricular function and AKI in a subpopulation with documented admission physical examinations.MethodsAmong 1879 critically ill patients with echocardiographic ventricular measurements, 43% (n = 807) had ventricular dysfunction—21% (n = 388), 9% (n = 167), and 13% (n = 252) with isolated left ventricular dysfunction, isolated right ventricular dysfunction, and biventricular dysfunction, respectively. Overall, ventricular dysfunction was associated with a 43% higher adjusted risk of AKI (95% confidence interval [CI] 1.14–1.80; P = 0.002) compared with those with normal biventricular function, whereas isolated left ventricular dysfunction, isolated right ventricular dysfunction, and biventricular dysfunction were associated with a 1.34 (95% CI 1.00-1.77, P = 0.05), 1.35 (95% CI 0.90–2.10, P = 0.14) and 1.67 (95% CI 1.23–2.31, P = 0.002) higher adjusted risk. Although an episode of AKI was associated with an approximately 2-fold greater risk of hospital mortality in those with isolated left ventricular dysfunction and biventricular dysfunction, in those with isolated right ventricular dysfunction, AKI was associated with a 7.85-fold greater risk of death (95% CI 2.89–21.3, P < 0.001). Independent of ventricular function, peripheral edema was an important determinant of AKI.DiscussionLike left ventricular function, right ventricular function is an important determinant of AKI and AKI-associated mortality. Volume overload, independently of ventricular function, is a risk factor for AKI. Whether establishment of euvolemia might mitigate AKI risk will require further study.

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Section: Discussionmentioning

confidence: 99%

Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness

Chen

Lee

Johnson

et al. 2017

Kidney International Reports

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“…That mean LVEF could not predict the 28-day mortality in pediatric severe sepsis with LVSD. In another similar study by Prabhu et al, [5] AUC was 0.656.…”

Section: Discussionmentioning

confidence: 81%

“…Although people have a widely known about sepsis-induced myocardial dysfunction, some study found that lower LVEF with better prognosis, but its association with the prognostic was still in controversial. [2,3,16] Prabhu [5] suggested that LVSD was associated with the mortality of septic shock in adults, Weng [17] found similar results. Conversely, a meta-analysis by Sevilla Berrios [18] showed that LVSD which defined by LVEF <50% was not correlated with the prognosis of severe sepsis or septic shock in adults.…”

Section: Discussionmentioning

confidence: 94%

The prognostic value of left ventricular systolic function and cardiac biomarkers in pediatric severe sepsis

Ning

Wang

et al. 2019

Medicine

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Echocardiography and cardiac biomarkers, such as cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are useful tools to evaluate cardiac dysfunction. Left ventricular systolic dysfunction (LVSD) is common in pediatric severe sepsis. The aim of this study is to evaluate the prognostic value of LVSD, cTnI, and NT-pro BNP for pediatric severe sepsis. A prospective, single center, observational study was conducted. Severe sepsis children were enrolled in the study from December 2015 to December 2016 in pediatric intensive care unit of Shanghai Children's Medical Center. Recorded general information, transthoracic echocardiography were performed at day 1, 2, 3, 7, and 10, using Simpson to measure left ventricular end-diastolic dimension and left ventricular end-systolic dimension, obtained echocardiography parameters: left ventricular ejection fraction (LVEF), left ventricular fractional shortening, left ventricular end-diastolic volume, left ventricular end- systolic volume, stroke volume, cardiac output. At the same time collecting the blood sample to measure cTnI, NT-pro BNP. The definition of LVSD was LVEF <50%. According to the prognosis of 28 days, children with severe sepsis were divided into survived group and nonsurvived group. Total of 50 pediatric patients who were diagnosed with severe sepsis (including septic shock) were enrolled, the incidence of LVSD was 52%. The 28-day mortality rate of severe sepsis was 34%. Multivariate logistic regression analyses for predictors of death in pediatric severe sepsis revealed that the 28-day mortality of severe sepsis was associated with mechanical ventilation (MV) within the first 6 hours of admission (odds ratio [OR], 0.01; 95% confidence interval [CI], 0.00–0.07) and total MV time (OR, 0.81; 95% CI, 0.68–0.97). The receiver operating characteristic curves LVEF (area under curve = 0.526), cTnI (area under curve = 0.480), and NT-pro BNP (area under curve = 0.624) were used to predict the 28-day mortality in pediatric severe sepsis. Follow-up echocardiography parameters for survived group and nonsurvived group showed no significant changes in LVEF, LVFS, stroke volume index, cardiac index (CI), left ventricular end-diastolic volume index and left ventricular end-systolic volume index at day 1, 2, 3, 7, and 10, except for CI at day 1 and 2. Kaplan–Meier plot of 28-day mortality and LVSD in pediatric severe sepsis showed there were no statistical differences ( χ 2 = 0.042, P = .837). LVSD occurs frequently in pediatric with severe sepsis. The 28-day mortality rate of severe sepsis was also high. In this study, none of LVSD, cTnI, and NT-proBNP was associated with the prognosis of pediatric severe sepsis.

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“…In the pediatric cohort evaluated in this study, the influence of SIMD on mortality was not assessed due to limited number of events (mortality rate < 5%). Evaluating a larger population powered to assess morbidity and mortality is necessary since SIMD may potentially have an association with sepsis mortality [6] [7]. …”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the prevalence of pediatric sepsis has increased from 3.7% to 4.4% in the past decade with small improvements in outcome [3]. In the progression of severe sepsis and septic shock, sepsis induced myocardial dysfunction (SIMD) is being increasingly recognized [4] [5] with evidence suggesting an association between myocardial dysfunction in sepsis and mortality [6] [7]…”

Section: Introductionmentioning

confidence: 99%

Strain Echocardiography Parameters Correlate With Disease Severity in Children and Infants With Sepsis*

Haileselassie

Pozios

et al. 2016

Pediatric Critical Care Medicine

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Background In the progression of severe sepsis, sepsis-induced myocardial dysfunction (SIMD) contributes to severity of illness and ultimate mortality. Identification of SIMD causing depressed cardiac function during critical illness has implications for ongoing patient management. However, assessing pediatric cardiac function traditionally relies on echocardiographic qualitative assessment and measurement of left ventricular ejection fraction (EF) or fractional shortening (FS). These metrics are often insensitive for detecting early or regional myocardial dysfunction. Strain echocardiography (SE) is a contemporary echocardiographic modality that may be more sensitive to perturbations in cardiac function. This investigation hypothesizes that SE metrics correlate with severity of illness in pediatric sepsis despite normal FS. Design Single-center retrospective observational study. Setting Tertiary 36-bed medical/surgical pediatric intensive care unit. Patients Pediatric patients admitted with sepsis. Interventions None. Measurements and Main Results Twenty-three children with sepsis received an echocardiogram in the study period. Patients with sepsis demonstrated abnormal peak systolic longitudinal strain for age (mean = −0.13 ±0.07, p < 0.01) and low normal peak systolic circumferential strain (mean = −0.17± 0.14 P= 0.02) compared to internal controls as well as previously published normal values. Depressed strain was demonstrated in the septic patients despite having normal FS (mean = 0.41, 95% CI 0.38 – 0.43). On initial echocardiographic imaging, worsening peak systolic longitudinal strain was associated with increasing lactate (p= 0.04). Conclusion Pediatric patients with sepsis demonstrate evidence of depressed SE parameters not shown by FS that correlate with clinical indices of sepsis severity. Whether SE could eventually assist in grading pediatric sepsis severity and affect management is an area for potential future investigation.

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Prognosis of Left Ventricular Systolic Dysfunction in Septic Shock Patients

Cited by 13 publications

References 27 publications

Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness

Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness

The prognostic value of left ventricular systolic function and cardiac biomarkers in pediatric severe sepsis

Strain Echocardiography Parameters Correlate With Disease Severity in Children and Infants With Sepsis*

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