Citation Information :
Bansal S, Varshney S, Shrivastava A. A Prospective Observational Study to Determine Incidence and Outcome of Sepsis-induced Cardiomyopathy in an Intensive Care Unit. Indian J Crit Care Med 2022; 26 (7):798-803.
Introduction: Sepsis leads to left and/or right ventricular systolic and/or diastolic dysfunction resulting in adverse outcomes. Myocardial dysfunction can be diagnosed by echocardiography (ECHO) and early intervention can be planned. There are lacunae in Indian literature regarding the true incidence of septic cardiomyopathy and its influence on the outcome of patients admitted to intensive care unit (ICU).
Materials and methods: This prospective observational study was conducted on patients consecutively admitted with sepsis to the ICU of a tertiary care hospital in North India. In these patients, ECHO was performed after 48–72 hours to establish left ventricular (LV) dysfunction, in whom the ICU outcome was analyzed.
Result: The incidence of LV dysfunction was 14%. About 42.86% of patients had isolated systolic dysfunction, 7.14% of patients had isolated diastolic dysfunction, and 50.00% of patients had combined LV systolic and diastolic dysfunctions. The average days of mechanical ventilation in patients without LV dysfunction group (group I) was 2.41 ± 3.82 days as compared to 4.43 ± 4.27 days in patients with LV dysfunction (group II) (p = 0.034). Incidence of all-cause ICU mortality was 11 (12.79%) in group I and 3 (21.43%) in group II (p = 0.409). The mean duration of stay in ICU was 8.26 ± 4.41 days in group I as compared to 13.21 ± 6.83 days in group II.
Conclusion: We concluded that sepsis-induced cardiomyopathy (SICM) in ICU is quite prevalent and clinically significant. All-cause ICU mortality and length of ICU stay are prolonged in patients with SICM.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
Antonucci E, Fiaccadori E, Donadello K, Taccone FS, Franchi F, Scolletta S. Myocardial depression in sepsis: from pathogenesis to clinical manifestations and treatment. J Crit Care 2014;29(4): 500–511. DOI: 10.1016/j.jcrc.2014.03.028.
Narvaez I, Canabal A, Martín C, Sánchez M, Moron A, Alcala J, et al. Incidence and evolution of sepsis-induced cardiomyopathy in a cohort of patients with sepsis and septic shock. Med Intensiva (English Edition) 2018;42(5):283–291. DOI: 10.1016/j.medin.2017.08.008.
L’Heureux M, Sternberg M, Brath L, Turlington J, Kashiouris MG. Sepsis-induced cardiomyopathy: a comprehensive review. Curr Cardiol Rep 2020;22(5):1–2. DOI: 10.1007/s11886-020-01277-2.
Hanumanthu BK, Laniado I, Offor LO, Kushwaha A, Sasidharan NA, Krishnan A, et al. Sepsis induced cardiomyopathy confers higher mortality in patients with septic shock. Circulation 2019;140(Suppl_1):A13772. DOI: 10.1161/circ.140.suppl_1.13772.
Li Y, Li H, Zhang D. Analysis of incidence and risk factors of septic cardiomyopathy. Chin J Emerg Med 2019;28:836–840. DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.07.006.
Sato R, Kuriyama A, Takada T, Nasu M, Luthe SK. Prevalence and risk factors of sepsis-induced cardiomyopathy: a retrospective cohort study. Medicine 2016;95(39):e5031. DOI: 10.1097/MD.0000000000005031.
Havaldar AA. Evaluation of sepsis induced cardiac dysfunction as a predictor of mortality. Cardiovasc Ultrasound 2018;16(1):1–7. DOI: 10.1186/s12947-018-0149-4.
Bergenzaun L, Öhlin H, Gudmundsson P, Willenheimer R, Chew MS. Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients. Cardiovasc Ultrasound 2013;11(1):1–8. DOI: 10.1186/1476-7120-11-16.
Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, et al. Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 1984;100(4):483–490. DOI: 10.7326/0003-4819-100-4-483.
Landesberg G, Jaffe AS, Gilon D, Levin PD, Goodman S, Abu-Baih A, et al. Troponin elevation in severe sepsis and septic shock: the role of left ventricular diastolic dysfunction and right ventricular dilatation. Crit Care Med 2014;42(4):790–800. DOI: 10.1097/CCM.0000000000000107.
Sturgess DJ, Marwick TH, Joyce C, Jenkins C, Jones M, Masci P, et al. Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers. Crit Care 2010;14(2):R44. DOI: 10.1186/cc8931.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Classification proposed by the third universal definition of myocardial infarction. Eur Heart J 2012;33(20): 2551–2567. DOI: 10.1093/eurheartj/ehs184.