PURPOSE: To investigate the morbidity and mortality of patients with sepsis and septic shock in relationship to presence of LV dysfunction(LVD).
METHODS: Retrospective review of sepsis patients. Data collected were demographics, admission diagnosis, ECHO findings (LVEF & LVEDD) and presence of inotropes and vasopressors in shock patients. Data were analyzed on number of hospital days,number of days on ventilator, and final outcome.Patients with sepsis and shock were divided based on the presence or absence of LVD. LVD defined as either LV-EF<40% or LV-end-diastolic dimension(LVEDD)>5.6cm.
RESULTS: 117sepsis patients with mean age of 62. 82patients had shock,mean length of stay was 26days.33patients(28%)had LVD and only 4patients survived; while 25 out of 84 patients with normal LV-function died,p-value=0.047. The two propotion T-test was done comparing the two variables used in our study (LVEF &LVEDD).68 out of 93 sepsis patients with normal LVEF survived p(1)=73.12%,19 out of 23 patients with low LVEF survived p(2)= 82.61%;P-Value=0.299.74 out of 102 patients with normal LVEDD survived p(1)=72.55%.13 out of 14 patients with increased LVEDD survived p(2)=92.86%;P-value=0.013.LVEDD Regression Testing and analysis of variance showed P-value=0.06 indicating a significant causal relationship between LVEDD and mortality.However, similar results were not observed in septic shock patients.Comparison of patients with the presence and absence of septic shock,the p-value=0.91.Similarly shock patients with and without LVD when compared with the use of vasopressors and inotropes showed no significant relationship,p- values were(0.36)and(0.76)respectively.24 patients with shock died as compared to 62 patients who survived,and among the patients who did not have shock 5 patients died whereas 26 survived;p-value=0.192.LV function did not correlate with morbidity measures ventilator days&LOS (T-values were 0.61and0.85 respectively).
CONCLUSION: Normal LV function in septic patient carries higher risk of death.LVD(defined by increased LVEDD)led to better survival. There was no significant relationship between lowering of EF and survival.LV function did not correlate with morbidity measures (ventilator days&LOS).Shock in our septic patients was not associated with increased risk of LV dysfunction or death.
CLINICAL IMPLICATIONS: Left ventricular end diastolic dimension could be used as a predictor of outcome in patients with sepsis.
DISCLOSURE: Asha Potti, No Financial Disclosure Information; No Product/Research Disclosure Information