Acute Crit Care.  2020 May;35(2):67-76. 10.4266/acc.2020.00024.

Predictors and outcomes of sepsis-induced cardiomyopathy in critically ill patients

• Song MJ
• Lee SH
• Leem AY
• Kim SY
• Chung KS
• Kim EY
• Jung JY
• Kang YA
• Kim YS
• Chang J
• Park MS

• KMID: 2502336
• DOI: http://doi.org/10.4266/acc.2020.00024

Abstract

Background
Sepsis-induced cardiomyopathy (SIC) occurs frequently in critically ill patients, but the clinical features and prognostic impact of SIC on sepsis outcome remain controversial. Here, we investigated the predictors and outcomes of SIC.
Methods
Patients admitted to a single medical intensive care unit from June 2016 to September 2017 were retrospectively reviewed. SIC was diagnosed by ejection fraction (EF) <50% and ≥10% decrease in baseline EF that recovered within 2 weeks.
Results
In total, 342 patients with sepsis met the inclusion criteria, and 49 patients (14.3%) were diagnosed with SIC; the latter were compared with 259 patients whose EF was not deteriorated by sepsis (non-SIC). Low systolic blood pressure and increased left ventricular enddiastolic diameter (LVEDD) were identified as predictors of SIC. SIC and non-SIC patients did not differ significantly in terms of 28-day all-cause mortality (24.5% vs. 26.3%, P=0.936). Acute Physiology and Chronic Health Evaluation II (APACHE II; hazard ratio [HR], 1.10; 95% confidential interval [CI], 1.02 to 1.18; P=0.009) and delta neutrophil index (DNI; HR, 1.02; 95% CI, 1.00 to 1.08; P=0.026) were independent risk factors for 28-day mortality with SIC. DNI, APACHE II, and lactate were identified as risk factors for 28-day mortality in sepsis patients as a whole.
Conclusions
SIC was not associated with increased mortality compared to non-SIC. Low systolic blood pressure and increased LVEDD were predictors of SIC. High APACHE II score and elevated DNI, which reflect sepsis severity, predict 28-day all-cause mortality.

Keyword

APACHE; delta neutrophil index; left; mortality; prognosis; sepsis; ventricular dysfunction

Figure

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  Figure 1. Patient recruitment flowchart. ICU: intensive care unit; TTE: transthoracic echocardiography; LV: left ventricle; SIC: sepsis-induced cardiomyopathy. aPatients without follow-up TTE showed poor mortality outcome. Lack of follow-up TTE in this group was due to several reasons: eight patients (42.1%) died within 72 hours after ICU admission, end-of-life decisions were made for six patients (31.6%), two patients were transferred to other hospitals, and three patients (15.8%) recovered from sepsis.

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