Prevalence and risk factors of sepsis-induced cardiomyopathy

Abstract

The aim of the study is to evaluate the epidemiology and clinical features of sepsis-induced cardiomyopathy (SICM).A retrospective cohort study was conducted.A total of 210 adult patients with sepsis or septic shock admitted to a Japanese tertiary care hospital from January 1, 2013, to December 31, 2015, who underwent transthoracic echocardiography (TTE) on admission.The definition of SICM was ejection fraction (EF) < 50% and a ≥10% decrease compared to the baseline EF which recovered within 2 weeks, in sepsis or septic shock patients.Our primary outcome was the incidence rate of SICM. Our secondary outcomes were the in-hospital mortality rate and length of intensive care unit (ICU) stay according to the presence or absence of SICM. In total, 29 patients (13.8%) were diagnosed with SICM. The prevalence rate of SICM was significantly higher in male than in female (P = 0.02). Multivariate logistic regression analyses revealed that the incidence of SICM was associated with younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95–0.99), higher lactate level on admission (OR, 1.18; 95% CI, 1.05–1.32) and history of heart failure (HF) (OR, 3.77; 95% CI, 1.37–10.40). There were no significant differences in the in-hospital and 30-day mortality between patients with and without SICM (24.1% vs 12.7%, P = 0.15; 20.7% vs 12.1%, P = 0.23). Lengths of hospital and ICU stay were significantly longer in patients with SICM than in those without SICM (median, 43 vs 26 days, P = 0.04; 9 vs 5 days, P < 0.01).SICM developed in 13.8% of patients with sepsis and septic shock. A younger age, higher lactate levels on admission and history of HF were risk factors.

Administration of nicotinamide riboside prevents oxidative stress and organ injury in sepsis

“…Acute lung injury (ALI) and myocardial dysfunction frequently occur and significantly contribute to septic death [4–6]. Histopathologic changes of ALI and septic heart include accumulation of activated neutrophils and macrophages, apoptosis, pro-inflammatory response and increased pulmonary capillary permeability [7–9].…”

Influenza‐associated septic shock accompanied by septic cardiomyopathy that developed in summer and mimicked fulminant myocarditis

“…However, both reports were complicated by bacterial infection. A Japanese retrospective cohort study reported that SC developed in 13.8% (29/210) of patients with sepsis and septic shock . In this study, 37.9% (11/29) of patients with SC did not show pathogenic microorganisms and some of these patients has possible viral infections.…”

“…Although SC sometimes requires such invasive mechanical support, SC improves within a relatively short period with optimal treatment for sepsis. Moreover, management of patients who require extracorporeal membrane oxygenation is complex . A recent systematic MEDLINE database review of influenza myocarditis between 1946 and 2017 summarized 184 cases of patients suffering from influenza myocarditis .…”

Invasive Pneumococcal Disease: Still Lots to Learn and a Need for Standardized Data Collection Instruments

“…A striking finding from our study was that 35% of patients who had an echocardiogram performed had an ejection fraction of <50% indicating systolic dysfunction. Myocardial dysfunction in sepsis has been recognized for some time and this dysfunction may be systolic or diastolic [59–61]. While several factors may play a role in the pathogenesis of cardiovascular complications during the course of IPD the pneumococcus does play a direct role.…”