Predictors and outcomes of sepsis-induced cardiomyopathy in critically ill patients

Abstract

Background: Sepsis-induced cardiomyopathy (SIC) occurs frequently in critically ill patients, but the clinical features and prognostic impact of SIC on sepsis outcome remain controversial. Here, we investigated the predictors and outcomes of SIC.

Methods: Patients admitted to a single medical intensive care unit from June 2016 to September 2017 were retrospectively reviewed. SIC was diagnosed by ejection fraction (EF) <50% and ≥10% decrease in baseline EF that recovered within 2 weeks.

Results: In total, 342 patients with sepsis met the inclusion criteria, and 49 patients (14.3%) were diagnosed with SIC; the latter were compared with 259 patients whose EF was not deteriorated by sepsis (non-SIC). Low systolic blood pressure and increased left ventricular end-diastolic diameter (LVEDD) were identified as predictors of SIC. SIC and non-SIC patients did not differ significantly in terms of 28-day all-cause mortality (24.5% vs. 26.3%, P=0.936). Acute Physiology and Chronic Health Evaluation II (APACHE II; hazard ratio [HR], 1.10; 95% confidential interval [CI], 1.02 to 1.18; P=0.009) and delta neutrophil index (DNI; HR, 1.02; 95% CI, 1.00 to 1.08; P=0.026) were independent risk factors for 28-day mortality with SIC. DNI, APACHE II, and lactate were identified as risk factors for 28-day mortality in sepsis patients as a whole.

Conclusions: SIC was not associated with increased mortality compared to non-SIC. Low systolic blood pressure and increased LVEDD were predictors of SIC. High APACHE II score and elevated DNI, which reflect sepsis severity, predict 28-day all-cause mortality.

Keywords: APACHE; delta neutrophil fraction; ejection fraction; mortality; prognosis; sepsis.

Figure 1.

Patient recruitment flowchart. ICU: intensive care unit; TTE: transthoracic echocardiography; LV: left ventricle; SIC: sepsis-induced cardiomyopathy. ^aPatients without follow-up TTE showed poor mortality outcome. Lack of follow-up TTE in this group was due to several reasons: eight patients (42.1%) died within 72 hours after ICU admission, end-of-life decisions were made for six patients (31.6%), two patients were transferred to other hospitals, and three patients (15.8%) recovered from sepsis.