Search

The impact of left ventricular (LV) systolic function on outcomes in patients with sepsis and septic shock remains uncertain. The association, if any, may be nonlinear. Is LV systolic dysfunction associated with increased mortality among patients with sepsis and septic shock? Retrospective cohort study comprising all adult patients admitted to the medical ICU from January 1, 2011, through December 31, 2020, with sepsis and septic shock as defined by the Third International Consensus Definitions for Sepsis and Septic Shock guidelines. All adult patients with sepsis or septic shock who underwent transthoracic echocardiography within 3 days from admission to the medical ICU were included. We divided patients into five groups based on LV ejection fraction (LVEF). In addition to univariate analysis, we also performed multivariate logistic regression analysis adjusting for patients' baseline characteristics and severity of illness. The primary outcome was the association between each classification of LVEF and in-hospital mortality. A total of 3,151 patients were included in this study (LVEF < 25%, 133 patients; 25% ≤ LVEF < 40%, 305 patients; 40% ≤ LVEF < 55%, 568 patients; 55% ≤ LVEF < 70%, 1,792 patients; and LVEF ≥ 70%, 353 patients). In-hospital mortalities in each LVEF category were 51.1%, 34.8%, 26.6%, 26.2%, and 41.9%, respectively. In the multivariate logistic regression analysis, LVEF of < 25% (OR, 2.75; 95% CI, 1.82-4.17; P <.001) and LVEF of ≥ 70% (OR, 1.70; 95% CI, 1.09-1.88; P =.010) were associated independently with significantly higher in-hospital mortality compared with the reference LVEF category of 55% to 70%. The association of LVEF to in-hospital mortality in sepsis and septic shock was U-shaped. Both severe LV systolic dysfunction (LVEF < 25%) and hyperdynamic LVEF (LVEF ≥ 70%) were associated independently with significantly higher in-hospital mortality. [ABSTRACT FROM AUTHOR]

Sepsis, septic shock, and transthoracic echocardiogram (TTE) were identified using the International Classification of Diseases, Tenth Revision codes. B Introduction: b While the current Surviving Sepsis Campaign Guidelines suggests echocardiogram for the hemodynamic assessment in sepsis and septic shock, the evidence to support the utility of echocardiogram has been limited. B Conclusions: b This study using the large national database described that the use of TTE was associated with significantly lower in-hospital mortality in patients with septic shock while it was not in patients with sepsis without septic shock. [Extracted from the article]

Septic cardiomyopathy is associated with poor outcomes but its definition remains unclear. In a previous meta-analysis, left ventricular (LV) longitudinal strain (LS) showed significant prognostic value in septic patients, but findings were not robust due to a limited number of studies, differences in effect size and no adjustment for confounders. We conducted an updated systematic review (PubMed and Scopus up to 14.02.2023) and meta-analysis to investigate the association between LS and survival in septic patients. We included studies reporting global (from three apical views) or regional LS (one or two apical windows). A secondary analysis evaluated the association between LV ejection fraction (EF) and survival using data from the selected studies. We included fourteen studies (1678 patients, survival 69.6%) and demonstrated an association between better performance (more negative LS) and survival with a mean difference (MD) of −1.45%[−2.10, −0.80] (p < 0.0001;I2 = 42%). No subgroup differences were found stratifying studies according to number of views used to calculate LS (p = 0.31;I2 = 16%), severity of sepsis (p = 0.42;I2 = 0%), and sepsis criteria (p = 0.59;I2 = 0%). Trial sequential analysis and sensitivity analyses confirmed the primary findings. Grade of evidence was low. In the included studies, thirteen reported LVEF and we found an association between higher LVEF and survival (MD = 2.44% [0.44,4.45]; p = 0.02;I2 = 42%). We confirmed that more negative LS values are associated with higher survival in septic patients. The clinical relevance of this difference and whether the use of LS may improve understanding of septic cardiomyopathy and prognostication deserve further investigation. The association found between LVEF and survival is of unlikely clinical meaning. PROSPERO number CRD42023432354 [ABSTRACT FROM AUTHOR]

Further research is needed to establish the utility of these distinct LV systolic function phenotypes in outcomes of patient with sepsis and septic shock. B Conclusions: b In this analysis of systolic function among patients with sepsis, (LVEF >= 55% & MASV < 8.5 cm/sec) and (LVEF < 55 & MASV < 8.5 cm/sec) phenotypes were associated with higher mortality. The ICU mortality was 28% for the phenotype; 36% for the phenotype; 29% for the phenotype; and 35% for the phenotype. [Extracted from the article]

B Introduction: b Septic shock patients have heterogeneous and dynamic cardiovascular dysfunction. B Methods: b This retrospective study included patients with septic shock receiving vasopressin as a catecholamine adjunct who had an echo performed after shock onset and prior to vasopressin initiation. Patients with LV systolic dysfunction were less frequently vasopressin responsive (with LV dysfunction: 10/27 [37%] vs. without LV dysfunction: 62/102 [61%], absolute difference -24%; 95% CI -44% to -3%). [Extracted from the article]