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. 2024 Apr 1;10(8):e28956.
doi: 10.1016/j.heliyon.2024.e28956. eCollection 2024 Apr 30.

Cardiac index and heart rate as prognostic indicators for mortality in septic shock: A retrospective cohort study from the MIMIC-IV database

Chansokhon Ngan  1 , Xueying Zeng  1 , Thongher Lia  2 , Wanhong Yin  1 , Yan Kang  1
Affiliations

Cardiac index and heart rate as prognostic indicators for mortality in septic shock: A retrospective cohort study from the MIMIC-IV database

Chansokhon Ngan et al. Heliyon. .

Abstract

Background: Septic shock is a life-threatening condition that can lead to organ dysfunction and death. In the ICU, monitoring of cardiac index (CI) and heart rate (HR) is commonly used to guide management and predict outcomes in septic shock patients. However, there is a lack of research on the association between CI and HR and the risk of mortality in this patient population. Therefore, the aim of this study was to investigate the relationship between different levels of CI and HR and mortality in septic shock patients.

Methods: Data analysis was obtained from the MIMIC-IV version 2.0 database. Sepsis and septic shock were primarily defined by sepsis-3, the third international consensus on sepsis and septic shock. CI was computed using cardiac output (CO) and body surface area (BSA). To evaluate the incidence of CI with respect to each endpoint (7-, 14-, 21-, and 28-day mortality), a restricted cubic spline curve function (RCS) was used. The optimal cutoff value for predicted mortality was determined using the Youden index. Analyses of KM curves, cox regression, and logistic regression were conducted separately to determine the relationship between various CI and HR and 28-day mortality.

Results: This study included 1498 patients with septic shock. A U-shaped relationship between CI levels and risk of mortality in septic shock was found by RCS analysis (p < 0.001). CI levels within the intermediate range of 1.85-2.8 L/min/m2 were associated with a mortality hazard ratio (HR) < 1. In contrast, low CI (HR = 1.87 95% CI: 1.01-3.49) and high CI (HR = 1.93 95% CI: 1.26-2.97) had a significantly increased risk of mortality. The AUC for heart rate prediction of mortality by Youden index analysis was 0.70 95%CI:0.64-0.76 with a cut-off value of 93.63 bpm. According to the characteristics of HR and CI, patients were divided into six subgroups HR↓+CI intermediate group (n = 772), HR↓+CI↓ group (n = 126), HR↓+CI↑ group (n = 294), HR↑+CI intermediate group (n = 132), HR↑+CI↓ group (n = 24), and HR↑+CI↑ group (n = 150). The KM curves, COX regression, and logistic regression analysis showed that the survival rates the of HR↓+CI intermediate group, HR↓+CI↓ group, and HR↓+CI↑ were higher than the other groups. The risk factors of HR↑+CI intermediate group, HR↑+CI↓, and HR↑+CI↑ with ICU 28-day mortality were HR = 2.91 (95% CI: 1.39-5.97), HR = 3.67 (95% CI: 1.39-11.63), and HR = 5.77 (95% CI: 2.98-11.28), respectively.

Conclusion: Our retrospective study shows that monitoring cardiac index and heart rate in patients with septic shock may help predict the organismal response and hemodynamic consequences, as well as the prognosis. Thus, healthcare providers should carefully monitor changes in these parameters in septic shock patients transferred to the ICU for treatment.

Keywords: Cardiac index; Cardiac output; Heart rate; Hemodynamics; Prognosis; Sepsis; Septic shock.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yan Kang reports financial support was provided by 10.13039/501100013365West China Hospital of Sichuan University.

Figures

Fig. 1
Fig. 1
Flow chart of the Study population. MIMIC Medical Information Mart for Intensive Care.
Fig. 2
Fig. 2
Association between cardiac index levels and 7-, 14-,21-, and 28-day mortality in patients with septic shock. (A) The crude model for predicting 7-day mortality. (B) The predictive model adjusted for Age, Gender, BMI, SBP-mean, glucose-mean, AaDO2-max, PaO2/fiO2 ratio-max, platelets-max, creatinine-max, pt-max, and eGFR-max for 7-day mortality. (C) The crude model for predicting 14-day mortality. (D) The predictive model adjusted for Age, Gender, BMI, SBP-mean, glucose-mean, AaDO2-max, PaO2/fiO2 ratio-max, platelets-max, creatinine-max, pt-max, and eGFR-max for 14-day mortality. (E) The crude model for predicting 21-day mortality. (F) The predictive model adjusted for Age, Gender, BMI, SBP-mean, glucose-mean, AaDO2-max, PaO2/fiO2 ratio-max, platelets-max, creatinine-max, pt-max, and eGFR-max for 21-day mortality. (G) The crude model for predicting 28-day mortality. (H) The predictive model adjusted for Age, Gender, BMI, SBP-mean, glucose-mean, AaDO2-max, PaO2/fiO2 ratio-max, platelets-max, creatinine-max, pt-max, and eGFR-max for 28-day mortality.
Fig. 3
Fig. 3
Kaplan-Meier curve for survival analysis of three groups stratified by cardiac index levels.
Fig. 4
Fig. 4
Association between heart rate and 28-day mortality in patients with septic shock. (A) Receiver Operating Characteristic (ROC) curve analysis of heart rate predicts 28-day mortality in patients with septic shock risk stratification. The AUC of heart rate was 0.70 (0.63–0.76), and the cut-off value was 93.63 bpm. (B) Kaplan-Meier curve for survival analysis of two groups stratified by heart rate levels.
Fig. 5
Fig. 5
Kaplan-Meier curve for survival analysis of subgroups stratified by cardiac index and heart rate levels.
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