Myocardial Dysfunction in Severe Sepsis and Septic Shock

Landesberg, Giora; Levin, Phillip D.; Gilon, Dan; Goodman, Sergey; Georgieva, Milena; Weissman, Charles; Jaffe, Allan S.; Sprung, Charles L.; Barak, Vivian

doi:10.1378/chest.14-2259

Cited by 76 publications

(42 citation statements)

References 36 publications

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“…We speculated that sepsis-induced acute LV systolic or diastolic dysfunction, with decreased LV EF or elevated LV filling pressure, would be enough mechanical stress to release sST2. However, our findings did not support this hypothesis, similarly to the recent report that revealed no correlation between inflammatory cytokines and myocardial dysfunction in septic shock [15]. Sepsis itself may trigger sST2 release as an inflammatory mediator, covering up any sST2 upregulation from myocardial mechanical strain.…”

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confidence: 93%

Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis

et al. 2016

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Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated. Correlations between sST2 and other sepsis biomarkers (high-sensitivity C-reactive protein [hs-CRP] and procalcitonin) were also examined. sST2 showed a moderate correlation with mean arterial pressure (r=-0.3499) but no correlation with LV ejection fraction, diastolic filling, or resting pulmonary hypertension. It showed moderate correlations with hs-CRP and procalcitonin (r=0.2608 and r=0.3829, respectively). sST2 might have a role as a biomarker of shock or inflammation, but it cannot reflect echocardiographic findings of LV ejection fraction or diastolic filling in sepsis.

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confidence: 93%

Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis

et al. 2016

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“…First, organ failure scores, such as SOFA, are known to correlate poorly with pro-inflammatory cytokines in patients with sepsis. [21] Second, although SOFA and APACHE scores are useful in prognostication, the differential treatment responses observed in subphenotypes in our previous work were not identified when measures of severity were used to stratify the same population. [10] These findings suggest that the LCA approach to identifying subgroups cannot be reproduced using conventional measures of disease severity.…”

Section: Discussionmentioning

confidence: 94%

Latent class analysis of ARDS subphenotypes: a secondary analysis of the statins for acutely injured lungs from sepsis (SAILS) study

et al. 2018

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Purpose: Using latent class analysis (LCA), we have consistently identified two distinct subphenotypes in four randomized controlled trial cohorts of ARDS. One subphenotype has hyper-inflammatory characteristics and is associated with worse clinical outcomes. Further, within 3 negative clinical trials, we observed differential treatment response by subphenotype to randomly assigned interventions. The main purpose of this study was to identify ARDS subphenotypes in a contemporary NHLBI Network trial of infection-associated ARDS (SAILS) using LCA and to test for differential treatment response to rosuvastatin therapy in the subphenotypes. Methods: LCA models were constructed using a combination of biomarker and clinical data at baseline in the SAILS study (n=745). LCA modeling was then repeated using an expanded set of clinical class-defining variables. Subphenotypes were tested for differential treatment response to rosuvastatin. Results: The 2-class LCA model best fit the population. 40% of the patients were classified as the “hyper-inflammatory” subphenotype. Including additional clinical variables in the LCA models did not identify new classes. Mortality at Day 60 and Day 90 was higher in the hyper-inflammatory subphenotype. No differences in outcome were observed between hyper-inflammatory patients randomized to rosuvastatin therapy versus placebo. Conclusions: Using LCA, a 2-subphenotype model best described the SAILS population. The subphenotypes have features consistent with those previously reported in 4 other cohorts. Addition of new class-defining variables in the LCA model did not yield additional subphenotypes. No treatment effect was observed with rosuvastatin. These findings further validate the presence of two subphenotypes and demonstrates their utility for patient stratification in ARDS.

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“…Of the 46 studies included in this review, 35 examined the association of brain natriuretic peptides (BNP, NT‐proBNP) with survival in patients with septic shock, presented in Table . The vast majority were prospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…This association was also evaluated by two studies in the setting of an RCT evaluating the use of 20% human albumin plus crystalloids or crystalloids alone in patients with severe sepsis or septic shock . In total, 30 studies, including the two conducted in the setting of the RCT, have found a significant association between elevated levels of brain natriuretic peptides and increased mortality …”

Section: Resultsmentioning

confidence: 99%

“…The primary outcome of this systematic review was to assess the utility of BNP and NT‐proBNP as prognostic markers in septic shock. Brain natriuretic peptides have been shown to be adequate predictors of mortality in septic shock by numerous studies . However, there are significant differences in the reported limits for an optimal cut‐off value, ranging from 210 to 800 ng/L for BNP, with suboptimal sensitivity and specificity .…”

Section: Discussionmentioning

confidence: 99%

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The utility of brain natriuretic peptides in septic shock as markers for mortality and cardiac dysfunction: A systematic review

et al. 2019

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Objective To conduct a systematic review evaluating the utility of brain natriuretic peptide (BNP) and N‐terminal proBNP (NT‐proBNP) as biomarkers in adult patients with septic shock. Materials and Methods Pubmed/Medline databases were searched from inception to November 2018 using the search terms: (septic[Title/Abstract] AND shock[Title/Abstract]) AND bnp[Title/Abstract]) and (septic[Title/Abstract]) AND shock[Title/Abstract]) AND natriuretic[Title/Abstract]). No restriction was applied regarding date of publication. Comparative observational studies evaluating BNP and NT‐proBNP in patients with septic shock aged ≥18 years were eligible for inclusion. Bibliographies from the extracted articles were also reviewed to identify additional relevant publications. Results In total, 46 studies met all eligibility criteria and were included. A strong body of literature has demonstrated that in patients with septic shock, increased values of BNP and NT‐proBNP are associated with increased mortality. An increase from baseline BNP values has also been associated with increased mortality, whereas decreases from baseline values are not related to worse outcome. Brain natriuretic peptides have also been associated with cardiac dysfunction in patients with sepsis. Moreover, BNP values have been found to be significantly elevated in septic shock, regardless of cardiac dysfunction, and have been used to distinguish between septic and cardiogenic shock. Furthermore, BNP and NT‐proBNP are significantly increased in patients with septic shock, compared to patients with sepsis and severe sepsis. Conclusions BNP and NT‐proBNP appear to be reliable predictors of outcome in septic shock.

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Myocardial Dysfunction in Severe Sepsis and Septic Shock

Cited by 76 publications

References 36 publications

Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis

Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis

Latent class analysis of ARDS subphenotypes: a secondary analysis of the statins for acutely injured lungs from sepsis (SAILS) study

The utility of brain natriuretic peptides in septic shock as markers for mortality and cardiac dysfunction: A systematic review

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