Relation of Echocardiographic Parameters to Outcome of Patients with Severe Sepsis and Septic Shock

Abstract

Background: Myocardial dysfunction is one of the most important features of sepsis. The presence of cardiac dysfunction in sepsis has been associated with high mortality rate in septic patients. Material & Methods: This was prospective, observational cohort (patient with severe sepsis and septic shock) study conducted over period of one year in medical intensive care unit. Patients with an initial diagnosis of severe sepsis or septic shock were enrolled. Aims & Objectives:To study demographic profile, APACHE-II score and echocardiographic parameters in patients with severe sepsis and septic shock and to find out relation of echocardiographic parameters to variables of sepsis and outcome. Study Population: All patients underwent laboratory investigations, APACHE-II score and Transthoracic 2-Dimensional echocardiogram. Statistical analysis: Data was analysed by trial version SPSS-16 for mean, SD, chi-square test with'p' <0.05 was considered as statistically significant. Results: Of total 51 patients with sepsis and septic shock 32 were males and 19 were females with mean age of 51.48 (±13.11) years and 59.66 (±16.93) respectively. The mean LVEF was 35.70% (±7.47608). APACHE-II score had negative correlation with LVEF and positive with DD. Total 17.64% had normal LV diastolic function, 47.05% had grade-I diastolic dysfunction and 35.29% had grade-II diastolic dysfunction ['p'=0.082]. Overall mortality was 29.41% in patient with sepsis. Overall diastolic dysfunction was significantly more in patients with death compared to survived population ['p'= 0.0218 and 0.0329]. Conclusion: Diastolic dysfunction was common and a major predictor of mortality and outcome in severe sepsis and septic shock and was well correlated with APACHE-II score. Present study favors to use echocardiography as an ideal monitoring, tool in the septic patient for goal-oriented therapy for better outcome.

Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study

“…In contrast to our study, Patil et al found that the mean LVEF was 35.70% and more than 70% of septic patients had SD, and the mortality rate was high in patients with impaired EF (< 50%) more than patients with normal EF (15% vs. 34%, respectively). 11 Another study by Vieillard-Baron and colleagues on 67 patients free from previous cardiac disease and survived for > 48 h stated that global LV hypokinesia (EF < 45%) was found in 60% of the septic patients. 12 The left atrium (LA) size is used as a diagnostic criterion for DD.…”