Sepsis-induced cardiac dysfunction was a significant predictor of a composite of in-hospital mortality, prolonged hospital stay, and prolonged ICU stay (adjusted OR 2.2; 95% CI 1-4.7; p=0.039).
Cohort (n=128)
No
Does sepsis-induced cardiac dysfunction (SICD) or elevated NT-proBNP predict adverse clinical outcomes in patients admitted to the ICU with sepsis or septic shock?
Sepsis-induced cardiac dysfunction and NT-proBNP >9000 pg/ml are strong predictors of mortality and prolonged hospital or ICU stay in patients with sepsis or septic shock.
Odds Ratio: 2.2 (95% CI 1–4.7)
p-value: p=0.039
Abstract Introduction Sepsis-induced cardiac dysfunction (SICD) is a reversible type of cardiac disorder, with variable reported incidence and uncertain prognostic implications that can occur in patients with sepsis. The lack of a universal definition leads to high diagnosis variability. Forms of systolic and/or diastolic dysfunction of the left and/or right ventricle have been described. Aim This study aimed to identify patients with SICD, characterize their clinical and paraclinical features, analyse the different patterns of cardiac dysfunction and determine prognostic implications. Methods Patients admitted to the intensive care unit (ICU) for sepsis or septic shock who underwent TTE within 24 hours from admission between January 2023 and September 2024 were identified retrospectively. Exclusion criteria were acute myocardial infarction, severe left heart valve disease, previous cardiomyopathy, previously diagnosed severe, end-stage organ or oncological disease. Clinical, paraclinical and echocardiography data were documented. The primary outcome was a composite of in-hospital mortality, prolonged hospital stay (28 days) and prolonged ICU stay (7 days). Results A total of 128 patients were included, median age 72.5 years IQR 63, 81, 55.5 % male. More than a third of these patients developed SICD (37.5%). We identified four different types of cardiac dysfunction based on echocardiography (Figure 1). Patients with isolated LV systolic dysfunction were significantly younger than the rest of the group (median age 57 vs. 73, p=0.039). Total in-hospital mortality occurred in 56 patients (43.8%). Mortality rates did not differ significantly among the SICD groups. Clinical and paraclinical characteristics can be found in Figure 2. Even though the occurrence of SICD did not significantly predict mortality alone in this group, it was a significant predictor of composite outcome (OR = 2.211, 95% CI: 1–4.6, p = 0.037), even after adjusting for age and sex (OR 2.2, 95% CI: 1-4.7, p=0.039). NT-proBNP over 9000 pg/ml in this group of patients was a significant predictor of the composite outcome, even after adjustment for age and sex (OR 9.2, 95% CI: 3.2, 26.4, p0.001) and also a predictor of mortality even after adjustment for age and sex (OR 5.7, 95% CI: 2.2, 14.6, p0.001). These findings point out the importance of NT-proBNP as a prognostic marker in septic patients even in the absence of echographic evidence of cardiac dysfunction. Conclusion This study describes the incidence and spectrum of SICD in a group of septic patients admitted to a tertiary care hospital. Occurrence of any type of cardiac dysfunction associated with sepsis and high NT-proBNP levels had strong prognostic implications.Figure 1 Figure 2
Paraschiv et al. (Sat,) conducted a cohort in Sepsis or septic shock (n=128). Sepsis-induced cardiac dysfunction (SICD) vs. No sepsis-induced cardiac dysfunction was evaluated on Composite of in-hospital mortality, prolonged hospital stay (>28 days) and prolonged ICU stay (>7 days) (OR 2.2, 95% CI 1-4.7, p=0.039). Sepsis-induced cardiac dysfunction was a significant predictor of a composite of in-hospital mortality, prolonged hospital stay, and prolonged ICU stay (adjusted OR 2.2; 95% CI 1-4.7; p=0.039).