Echocardiographic Profile of Cirrhotic Patients with Sepsis and Septic Shock: A Propensity Score Matched Case-Control Study

Abstract

Background Our understanding of changes in hemodynamics in cirrhotic patients with sepsis and septic shock and its impact on outcomes remains limited. Our study aims to investigate differences in hemodynamic profiles using echocardiography between septic patients with and without cirrhosis. Methods This is a single-center, retrospective study of septic patients with echocardiogram within 3 days of a medical intensive care unit (MICU) admission. We compared baseline characteristics, echocardiographic parameters, and outcomes between patients with and without cirrhosis. A propensity score-matched case-control model was developed to describe the differences in hemodynamic parameters between the groups. Results 3,151 patients with sepsis and septic shock were included of which 421 (13%) had cirrhosis. In the propensity score model, cirrhotic patients had significantly higher left ventricular ejection fraction (63.4 vs. 56.2%, p < 0.001) and stroke volume (73.3 vs. 52.0 ml, p < 0.001) along with lower arterial elastance (Ea) (1.31 vs. 1.82, p < 0.001) and systemic vascular resistance (SVR) (1,110 vs. 1,370 dynes/sec/m− 5, p = 0.001). There was no difference between left ventricular elastance (Ees) (0.99 vs. 1.09, p = 0.107) and ventricular-arterial coupling (Ea/Ees) (1.29 vs. 1.40, p = 0.061). Conclusion Septic patients with cirrhosis had higher LVEF with a significantly higher percentage of hyperdynamic state than those without cirrhosis. Lower Ea and SVR without significant differences in Ees and Ea/Ees suggest vasodilation as the principal driver of the hyperdynamic profile in cirrhosis. This finding may facilitate tailored hemodynamic management focused on restoring vascular tone in cirrhotic septic patients.