Is Left Ventricular Systolic Dysfunction Associated With Increased Mortality Among Patients With Sepsis and Septic Shock?

Siddharth Dugar; Ryota Sato; Sanchit Chawla; Jee Young You; Xiaofeng Wang; Richard Grimm; Patrick Collier; Michael Lanspa; Abhijit Duggal

doi:10.1016/j.chest.2023.01.010

Is Left Ventricular Systolic Dysfunction Associated With Increased Mortality Among Patients With Sepsis and Septic Shock?

Chest. 2023 Jun;163(6):1437-1447. doi: 10.1016/j.chest.2023.01.010. Epub 2023 Jan 14.

Authors

Siddharth Dugar¹, Ryota Sato², Sanchit Chawla², Jee Young You², Xiaofeng Wang³, Richard Grimm⁴, Patrick Collier⁴, Michael Lanspa⁵, Abhijit Duggal⁶

Affiliations

¹ Respiratory Institute, Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH. Electronic address: dugars@ccf.org.
² Respiratory Institute, Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH.
³ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
⁴ Heart, Vascular, and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.
⁵ Critical Care Echocardiography Service, Intermountain Medical Center, Murray, Salt Lake City, UT; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
⁶ Respiratory Institute, Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH.

PMID: 36646415
DOI: 10.1016/j.chest.2023.01.010

Abstract

Background: The impact of left ventricular (LV) systolic function on outcomes in patients with sepsis and septic shock remains uncertain. The association, if any, may be nonlinear.

Research question: Is LV systolic dysfunction associated with increased mortality among patients with sepsis and septic shock?

Study design and methods: Retrospective cohort study comprising all adult patients admitted to the medical ICU from January 1, 2011, through December 31, 2020, with sepsis and septic shock as defined by the Third International Consensus Definitions for Sepsis and Septic Shock guidelines. All adult patients with sepsis or septic shock who underwent transthoracic echocardiography within 3 days from admission to the medical ICU were included. We divided patients into five groups based on LV ejection fraction (LVEF). In addition to univariate analysis, we also performed multivariate logistic regression analysis adjusting for patients' baseline characteristics and severity of illness. The primary outcome was the association between each classification of LVEF and in-hospital mortality.

Results: A total of 3,151 patients were included in this study (LVEF < 25%, 133 patients; 25% ≤ LVEF < 40%, 305 patients; 40% ≤ LVEF < 55%, 568 patients; 55% ≤ LVEF < 70%, 1,792 patients; and LVEF ≥ 70%, 353 patients). In-hospital mortalities in each LVEF category were 51.1%, 34.8%, 26.6%, 26.2%, and 41.9%, respectively. In the multivariate logistic regression analysis, LVEF of < 25% (OR, 2.75; 95% CI, 1.82-4.17; P < .001) and LVEF of ≥ 70% (OR, 1.70; 95% CI, 1.09-1.88; P = .010) were associated independently with significantly higher in-hospital mortality compared with the reference LVEF category of 55% to 70%.

Interpretation: The association of LVEF to in-hospital mortality in sepsis and septic shock was U-shaped. Both severe LV systolic dysfunction (LVEF < 25%) and hyperdynamic LVEF (LVEF ≥ 70%) were associated independently with significantly higher in-hospital mortality.

Keywords: ICU, critical illness; cardiac dysfunction; echocardiography; sepsis.

MeSH terms

Adult
Humans
Retrospective Studies
Sepsis*
Shock, Septic*
Ventricular Dysfunction, Left* / complications
Ventricular Dysfunction, Left* / diagnostic imaging
Ventricular Function, Left