Critical Care |

QRS Duration as a Prognosticator of ICU Sepsis Mortality FREE TO VIEW

Fariborz Rezai; Nida Junaid; Parikshit Prayag; Mujtaba Hasnain; Marci Handler; Shobana Sivan; Paul Yodice; Nirav Mistry; Kristin Fless
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Saint Barnabas Medical Center, Livingston, NJ

Chest. 2014;146(4_MeetingAbstracts):235A. doi:10.1378/chest.1990213
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SESSION TITLE: Sepsis & Septic Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Sepsis is defined as Systemic Inflammatory Response Syndrome (SIRS) in the presence of infection and is associated with high morbidity and mortality rates, particularly in the intensive care unit (ICU) setting. To date, biomarkers and sepsis scoring systems employed to predict sepsis prognosis have yielded results which are equivocal at best. Previous studies demonstrate that electrocardiogram (EKG) QRS complex prolongation is indicative of left ventricular (LV) dysfunction, a manifestation of the myocardial depression frequently seen in sepsis. Our study sought to determine the prognostic value of QRS duration in this patient population. We hypothesized that a prolonged QRS duration (≥ 120 ms) was predictive of poor outcomes in ICU patients with severe sepsis and septic shock.

METHODS: A retrospective chart review was performed of all patients admitted over an 18 month period to the ICU of our large academic community hospital with a primary diagnosis of severe sepsis or septic shock. 307 patients were identified, 43 of which were excluded due to arrhythmias, history of pacemaker placement or missing EKG data. Demographic and clinical variables (age, gender, EKG results and mortality) were abstracted and patients divided into two groups based on QRS duration (≥ 120 ms or < 120 ms). Categorical variables were analyzed using the chi-squared test. Statistical analysis was performed using IBM SPSS v21.0.0.

RESULTS: Among our study sample of 264 patients, severe sepsis and septic shock occurred most commonly in the 6th decade (mean age 67.4 +/- 17.4 years). Fifteen patients (5.7%) had a prolonged QRS duration (≥ 120 ms) of which 11 died, (mortality rate 73.3%) versus 31.7% mortality in the normal QRS group (< 120 ms). The overall ICU mortality rate for our study sample was 34.1%. The association between prolonged QRS and mortality in patients with a diagnosis of severe sepsis and septic shock was statistically significant (p=0.001).

CONCLUSIONS: This study suggests there is an association between prolonged QRS interval and mortality in septic adults in the ICU setting. We recommend further studies be done to validate the use of QRS duration as a sepsis prognosticator.

CLINICAL IMPLICATIONS: Our findings demonstrated an association between prolonged QRS duration and poor outcomes in ICU patients with severe sepsis and septic shock. This is an inexpensive tool that could be utilized by healthcare professionals in the ICU to predict the outcome of patients with severe sepsis and septic shock.

DISCLOSURE: The following authors have nothing to disclose: Fariborz Rezai, Nida Junaid, Parikshit Prayag, Mujtaba Hasnain, Marci Handler, Shobana Sivan, Paul Yodice, Nirav Mistry, Kristin Fless

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