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. 2021 Apr 13;9(1):33.
doi: 10.1186/s40560-021-00549-5.

Afterload-related cardiac performance identifies cardiac impairment and associates with outcome in patients with septic shock: a retrospective cohort study

Wei-Yan Chen #  1   2 , Zhen-Hui Zhang #  2 , Li-Li Tao  2 , Qi Xu  2 , Xing Wei  2 , Min-Sheng Chen  3   4   5   6
Affiliations

Afterload-related cardiac performance identifies cardiac impairment and associates with outcome in patients with septic shock: a retrospective cohort study

Wei-Yan Chen et al. J Intensive Care. .

Abstract

Background: Septic patients with cardiac impairment are with high mortality. Afterload-related cardiac performance (ACP), as a new tool for diagnosing septic cardiomyopathy (SCM), still needs to be evaluated for its impact on the prognosis for patients with septic shock.

Methods: In this retrospective study, 100 patients with septic shock undertaken PiCCO monitoring were included. The ability of ACP, cardiac index (CI), and cardiac power index (CPI) to discriminate between survivors and non-survivors was tested by comparing the area under the receiver operating characteristic curve (AUROC) analysis. Cox proportional hazards regression analyses were performed to assess the associations of ACP with day-28 mortality. Curve estimation was used to describe the relationship between the hazard ratio (HR) of death and ACP.

Results: ACP had a strong linear correlation with CI and CPI (P < 0.001). ACP demonstrated significantly greater discrimination for day-28 mortality than CI before adjusted [AUROC 0.723 (95% CI 0.625 to 0.822) vs. 0.580 (95% CI 0.468 to 0.692), P = 0.007] and CPI after adjusted [AUROC 0.693 (95% CI 0.590 to 0.797) vs. 0.448 (0.332 to 0.565), P < 0.001]. Compared with ACP > 68.78%, HR for ACP ≤ 68.78% was 3.55 (1.93 to 6.54) (P < 0.001). When adjusted with age, APACHE-II score, Vasoactive Inotropic Score, Lactate, CRRT, day-1 volume, fibrinogen and total bilirubin as possible confounders, and decrease ACP are still associated with increasing day-28 mortality (P < 0.05). An exponential relationship was observed between ACP12h and HR of day-28 death.

Conclusions: Our results suggested thatACP could improve mortality predictions when compared to CI and CPI. Decreased ACP was still an independent risk factor for increased day-28 mortality.

Keywords: Afterload-related cardiac performance; Cardiac index; Cardiac power index; Mortality; Septic cardiomyopathy.

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Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
Patient flow chart. ICU intensive care unit, PiCCO pulse indicator continuous cardiac output technology, CPR cardiopulmonary resuscitation
Fig. 2
Fig. 2
Correlation of ACP with traditional parameters. Calculations are based on all values collected at 12h after septic shock. CI cardiac index, ACP afterload-related cardiac performance, CPI cardiac power index
Fig. 3
Fig. 3
Area under the receiver operating characteristic curves (AUROCs) for day-7, day-14, and day-28 mortality for ACP, CI, and CPI
Fig. 4
Fig. 4
Relationship between parameters of cardiac function and hazard ratio of day-28 mortality in patients with septic shock. a Crude model of relationship between ACP12h and HR. b Adjusted model of relationship between ACP12h and HR, after adjustment for baseline risk of day-28 mortality (age, APACHE-II score, VIS, lactate, CRRT, day-1 volume, fibrinogen and total bilirubin). c. Crude model of relationship between CI12h and HR. d. Crude model of  relationship between CPI12h and HR
See this image and copyright information in PMC

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