Diastolic Dysfunction in Sepsis and Septic Shock: Which Parameters are Most Predictive?

• 出版年: Egyptian Journal of Critical Care Medicine
• 主要な著者: Mohamed Hamdi Saleh, Mohamed Elkhawaas, Randa Soliman, Shereen Elgenegeehy
• フォーマット: 論文
• 言語: 英語
• 出版事項: Springer 2023-03-01
• 主題: sepsis; septic shock; diastolic dysfunction
• オンライン･アクセス: https://doi.org/10.1097/EJ9.0000000000000061
• ISSN: 2090-7303; 2090-9209

Abstract Background Despite strong correlation between diastolic dysfunction and mortality in patients with sepsis, there is a wide range of discrepancy involving which echocardiographic parameters are most sensitive and predictive. Methods Seventy patients with sepsis were enrolled. Patients were stratified according to their systolic and diastolic functions into 4 groups. Prognosis was compared between the different groups. Different diastolic parameters were measured. Logistic regression analysis was used to determine which parameters are most predictive for poor prognosis. Results Mortality was significantly higher (68.4%) in patients who had combined systolic and diastolic dysfunction compared with other patients (p value <0.001). In addition, they had a higher incidence (36.8%) of developing acute kidney injury with a subsequent need for renal replacement therapy (P value: 0.008). Using multivariate regression analysis, E/A ratio and septal e′ are independent risk factors of mortality, with odds ratios 4.358 and 0.169 and P values 0.026 and 0.001, respectively. Using the receiver-operating characteristic curve, the cutoff values for these 2 parameters were 1.985 and 7.25 cm/sec, with areas under the curve 0.766 and 0.927, respectively. Conclusion Septic patients with combined systolic and diastolic dysfunction had a higher incidence of mortality. Both E/A and septal e′ can predict mortality in these patients.