Sepsis-Induced Cardiomyopathy Detected With Focused Cardiac Ultrasound in the Emergency Department

Abstract

Background: Sepsis is a high mortality condition characterized by multi-organ dysfunction. Sepsis-induced cardiomyopathy (SIC) refers to cardiac dysfunction in sepsis.

Objectives: Our goal was to determine whether SIC can be detected in the emergency department (ED) using focused cardiac ultrasound (FCU).

Methods: A retrospective analysis of adults presenting to a single ED with sepsis over a 21-month period was performed. Patients were included if they met clinical sepsis criteria, received an FCU by an emergency physician in the ED, and a baseline echocardiogram performed in the previous 12 months. SIC was defined as a significant decrease in estimated left ventricular ejection fraction (LVEF) by FCU relative to baseline. Demographic and outcome characteristics were compared between three cohorts: patients with normal baseline LVEF and no decrease on presentation, patients with decreased LVEF and no significant change, and those with a significant decrease in LVEF from their normal baseline (SIC).

Results: There were 110 patients that met inclusion criteria: 89 patients (81%) in the normal LVEF group, 12 (11%) in the prior decreased LVEF group, and 9 (8%) in the SIC group. Unadjusted mortality at 90 days for patients with SIC (67%) and prior decreased LVEF (58%) was significantly higher than those with normal EF (29%) (p = 0.019). When adjusted for age, gender, Charlson Index score, and lactate > 4.0 mmol/L, SIC was associated with mortality at 90 days (odds ratio 6.1, 95% confidence interval 1.37-32.92).

Conclusion: SIC can be detected using FCU by emergency physicians in the ED and is associated with increased 90-day mortality.

Keywords: cardiomyopathies; diagnostic ultrasound; echocardiography; emergency medicine; mortality; sepsis.