Left atrial function for outcome prediction in severe sepsis and septic shock: An echocardiographic study
Amr S. Omar, Masood ur Rahman, Said Abuhasna
Left atrial function, mortality, septic shock
Citation Information :
Omar AS, Rahman MU, Abuhasna S. Left atrial function for outcome prediction in severe sepsis and septic shock: An echocardiographic study. Indian J Crit Care Med 2009; 13 (2):59-65.
Left ventricular function and B-type natriuretic peptide (BNP) assessments are used to predict mortality in septic patients. Left atrial function has never been used to prognosticate outcome in septic patients. Objectives: To assess if deterioration of left atrial function in patients with severe sepsis and septic shock could predict mortality. Methods: We studied 30 patients with severe sepsis or septic shock with a mean age of 49.8±16.17. Echocardiographic parameters were measured on admission, Day 4, and Day 7, which comprised left ventricular ejection fraction (EF), and atrial function that is expressed as atrial ejection force (AEF). All patients were subjected to BNP assay as well. Multivariate analyses adjusted for APACHE II score was used for mortality prediction. Results: The underlying source for sepsis was lung in 10 patients (33%), blood in 7 patients (23.3%), abdomen in 7 patients (23.7%), and 3 patients (10%) had UTI as a cause of sepsis. Only one patient had CNS infection. In-hospital mortality was 23.3% (7 patients). Admission EF showed a significant difference between survivors and non survivors, 49.01±6.51 vs.. 56.44±6.93% (P < 0.01). On the other hand, admission AEF showed insignificant changes between the same groups, 10.9±2.81 vs. 9.41±2.4 k/dynes P=0.21, while BNP was significantly higher in the non survivors, 1123±236.08 vs. 592.7±347.1 pg/ml (P< 0.001). The predicatable variables for mortality was Acute Physiology and Chronic Health Evaluation II score, BNP, then EF. Conclusion: In septic patients, left atrial function unlike the ventricular function and BNP levels can not be used as an independent predictor of mortality.
Predicting outcome after ICU admission. The art and science of assessing risk. Chest 1992;102:1861-70.
APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
Clinical utility of transthoracic two-dimensional and Doppler echocardiography. J Am Coll Cardiol 1994;24:125-31.
Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis. Crit Care Med 2004;32:660-5.
Clinical usefulness and cost of echocardiography in patients admitted to a coronary care unit. Am J Cardiol 1997;80:1273-6.
Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure. J Am Coll Cardiol 1994;24:132-9.
Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 1984;100:483-90.
Atrial ejection force: a noninvasive assessment of atrial systolic function. J Am Coll Cardiol 1993;22:221-5.
Increased B-type natriuretic peptide level is a strong predictor for cardiac dysfunction in intensive care unit patients. Anaesth Intensive Care 2003;31:21-7.
Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644-55.
2001 SCCM/ ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6.
Septic shock. Lancet 2005;365:63-78.
Statistical methods for health care research fourth edition. University of Pennsilvania: Boston collage Lipincott U.S.A; 2001. p. 1-412
Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock. Chest 1988;93:903-10.
Right ventricular dysfunction and dilatation, similar to left ventricular changes, characterize the cardiac depression of septic shock in humans. Chest 1990;97:126-31.
Left ventricular systolic and diastolic function in septic shock. Intensive Care Med 1997;23:553-60.
Cardiac troponin I and T are biological markers of left ventricular dysfunction in septic shock. Clin Chem 2000;46:650-7.
Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock. Crit Care Med 2007;35:1019-26.
Natriuretic peptide system. Physiology and clinical utility. Curr Opin Crit Care 2004;10:336-41.
Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational study. J Am Coll Cardiol 2003;41:2010-7.
Society of Critical Care Medicine. Quality Indicators Committee. Candidate Critical Care Quality Indicators.: Society of Critical Care Medicine; 1995.
Critically ill patients readmitted to intensive care units-lessons to learn? Intensive Care Med 2003;29:241-8.
. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619-36.
Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med 1995;23:1177-83.
Patient selection for intensive care: A comparison of New Zealand and United States hospitals. Crit Care Med 1988;16:318-26.
Validation of a severity of illness score (APACHE II) in a surgical intensive care unit. Intensive Care Med 1989;15:519-22.
An initial comparison of intensive care in Japan and the United States. Crit Care Med 1992;20:1207-15.
Verification of the acute physiology and chronic health evaluation scoring system in a Hong Kong intensive care unit. Crit Care Med 1993;21:698-705.
Low cardiac function index predicts ICU mortality in patients with severe sepsis or septic shock. from 28th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium. 18-21 March 2008. Critical Care 2008, 12:P410doi:10.1186/cc6631.
Transthoracic echocardiography does not improve prediction of outcome over APACHE II in medical-surgical intensive. Can J Anaesth 2003;50:305-10.
Atrial Ejection Force in Systemic Autoimmune Diseases. Cardiology 1999;92:269-74.