Diastolic dysfunction and mortality in severe sepsis and septic shock

Giora Landesberg, Dan Gilon, Yuval Meroz, Milena Georgieva, Phillip D. Levin, Sergey Goodman, Alexander Avidan, Ronen Beeri, Charles Weissman, Allan S. Jaffe, Charles L. Sprung

Research output: Contribution to journalArticlepeer-review

198 Scopus citations

Abstract

Aims: Systolic dysfunction in septic shock is well recognized and, paradoxically, predicts better outcome. In contrast, diastolic dysfunction is often ignored and its role in determining early mortality from sepsis has not been adequately investigated. Methods and results: A cohort of 262 intensive care unit patients with severe sepsis or septic shock underwent two echocardiography examinations early in the course of their disease. All clinical, laboratory, and survival data were prospectively collected. Ninety-five (36%) patients died in the hospital. Reduced mitral annular e′-wave was the strongest predictor of mortality, even after adjusting for the APACHE-II score, low urine output, low left ventricular stroke volume index, and lowest oxygen saturation, the other independent predictors of mortality (Cox's proportional hazards: Wald = 21.5, 16.3, 9.91, 7.0 and 6.6, P< 0.0001, <0.0001, 0.002, 0.008, and 0.010, respectively). Patients with systolic dysfunction only (left ventricular ejection fraction ≤50%), diastolic dysfunction only (e′-wave <8 cm/s), or combined systolic and diastolic dysfunction (9.1, 40.4, and 14.1% of the patients, respectively) had higher mortality than those with no diastolic or systolic dysfunction (hazard ratio = 2.9, 6.0, 6.2, P = 0.035, <0.0001, <0.0001, respectively) and had significantly higher serum levels of high-sensitivity troponin-T and N-terminal pro-B-type natriuretic peptide (NT-proBNP). High-sensitivity troponin-T was only minimally elevated, whereas serum levels of NT-proBNP were markedly elevated [median (inter-quartile range): 0.07 (0.02-0.17) ng/mL and 5762 (1001-15 962) pg/mL, respectively], though both predicted mortality even after adjusting for highest creatinine levels (Wald = 5.8, 21.4 and 2.3, P = 0.015, <0.001 and 0.13). Conclusion: Diastolic dysfunction is common and is a major predictor of mortality in severe sepsis and septic shock. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Pages (from-to)895-903
Number of pages9
JournalEuropean heart journal
Volume33
Issue number7
DOIs
StatePublished - Apr 2012

Keywords

  • Diastolic dysfunction
  • Echocardiography
  • Heart failure with normal ejection fraction
  • Mortality
  • Sepsis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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