Doppler-defined pulmonary hypertension in sepsis and septic shock

Abstract

Background: The association of pulmonary hypertension (PH) in patients with sepsis is lesser understood.

Methods: This was a retrospective study of adult patients admitted to the intensive care unit during 2007-2014 for sepsis and septic shock, with echocardiography performed <72 h. PH was defined as tricuspid regurgitation peak velocity (TRV) > 3 m/s on Doppler echocardiography. Patients with prior PH, pulmonary stenosis, or without measurable TRV were excluded. Outcomes included 28-day mortality, one-year survival and length of stay.

Results: Eighty-three, of 241 (34.4%) patients included, had PH. Patients with PH were older and had greater cardiovascular comorbidity but similar illness severity, including acute respiratory distress syndrome and mechanical ventilation use. PH was an independent predictor of 28-day mortality (odds ratio 3.6 [95% confidence interval 1.1-12.5] p = .04). In a proportional hazards model, PH was an independent predictor of one-year survival (hazard ratio 1.7 [95% confidence interval 1.1-2.7]; p = .03). Severity of PH was associated with worse one-year survival but not 28-day mortality.

Conclusions: In patients with sepsis and septic shock, PH is common and is noted to be associated with higher short and long-term mortality. Further studies are needed to understand the mechanisms by which PH is associated with outcomes.

Keywords: Cardiopulmonary interactions; Echocardiography; Pulmonary hypertension; Right ventricle; Sepsis; Septic shock.