Incidence and outcomes of sepsis-related cardiomyopathy: A prospective cohort study

Abstract

Objective: To determine the incidence, predictive factors, and prognosis of sepsis-related cardiomyopathy. Materials and Methods: The present study was a prospective cohort study that enrolled adult septic shock patients admitted to the ICU of Siriraj Hospital (Bangkok, Thailand) between October 2013 and November 2014. All the patients were treated following the surviving sepsis campaign international guidelines 2012. Transthoracic echocardiography was performed during day 1, and then again during days 3 to 4 after septic shock diagnosis. Sepsis-related cardiopathy was diagnosed in patients who had left ventricular ejection fraction (LVEF) at less than 50%. The primary outcome was hospital mortality. The present study was registered in the Thai Clinical Trials Registry (TCTR20200818004). Results: Of the 75 patients enrolled, 24 (32%) were diagnosed as having sepsis-related cardiomyopathy, and 51 sepsis with preserved LVEF. Six of the 51 patients (11.8%) in the sepsis with preserved LVEF group, and nine of the 24 patients (37.5%) in the sepsis-related cardiomyopathy group died in the hospital (p=0.009). Multivariate analysis identified a maximum vasopressor dosage greater than 0.08 mcg/kg/minute and requiring renal replacement therapy as predictive factors associated with sepsis-related cardiomyopathy, while cirrhosis was identified as a protective factor. Sepsis-related cardiomyopathy, pneumonia, and requiring vasopressor were predictive factors associated with hospital mortality, while achieving tissue perfusion goals within six hours after resuscitation was a protective factor against in-hospital death. Conclusion: Sepsis-related cardiomyopathy was identified as a significant type of organ dysfunction among the present study sepsis or septic shock patients, and the mortality rate was high.