Incidence, prognosis, and risk factors of sepsis-induced cardiomyopathy

Abstract

Background: At present, large-scale studies on the clinical characteristics of sepsis-induced cardiomyopathy (SIC) are lacking.

Aim: To investigate the clinical characteristics of SIC.

Methods: Based on the analysis of the MIMIC-III public database, we performed a large-scale retrospective study involving sepsis patients who were admitted to the intensive care unit (ICU) and had no concomitant cardiac disease. We used propensity score matching analysis and multivariate logistic regression to ensure the robustness of the results. The primary outcome was hospital mortality, and the secondary outcomes included the number of patients who received mechanical ventilation or renal replacement therapy during their hospital stay, the number of patients administered with vasopressors, the length of ICU stay, and the length of hospital stay.

Results: In the present study, after screening 38605 patients, 3530 patients with sepsis were included. A total of 997 patients met the SIC diagnostic criteria, and the incidence of SIC was 28.20% (95% confidence interval [CI]: 26.80%-29.70%). Compared to patients in the non-SIC group, patients in the SIC group were of older age and had a higher Simplified Acute Physiology Score (SAPS)-I score, SAPS-II score, and Elixhauser comorbidity index (ECI). A total of 367 (36.8%) of 997 patients in the SIC group and 818 (32.3%) of 2533 patients in the non-SIC group died in the hospital, which resulted in a significant between-group difference (odds ratios = 1.22, 95%CI: 1.05-1.42; P = 0.011). For the secondary outcomes, more patients in the SIC group received mechanical ventilation and vasopressors. Multivariate logistic regression analysis showed that age, male sex, ECI, hemoglobin level, diabetes, and mechanical ventilation use on the first day of ICU admission were risk factors for SIC.

Conclusion: Compared with non-SIC patients, hospital mortality is higher in SIC patients.

Keywords: Hospital mortality; Incidence; MIMIC-III; Sepsis; Sepsis-induced cardiomyopathy; Septic shock.

Figure 1

Study screening and selection process. ICU: Intensive care unit; LVEF: Left ventricular ejection fraction; SIC: Sepsis-induced cardiomyopathy.

Figure 2

Subgroup analyses with regard to hospital mortality. BMI: Body mass index; SOFA: Sequential organ failure assessment, ranging from 0 to 24, with higher scores indicating a greater degree of organ failure; SBP: Systolic blood pressure; MAP: Mean arterial pressure; RRT: Renal replacement therapy.