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The exact mechanisms causing cardiac dysfunction in sepsis are still in major part obscure or controversial.
All patients who had the criteria for severe sepsis or septic shock underwent daily transthoracic echocardiography examinations from which detailed data on left ventricular end-diastolic, end-systolic volumes areas, and diastolic measurements were obtained. In addition, numerous clinical, hemodynamic, respiratory and laboratory data were prospectively collected, including data on survival up to 2 years after admission. Blood samples were collected, centrifuged and serum separated for additional biomarker tests, mainly troponin and NT-proBNP.
A total of 262 patients had 712 (2.5 ± 1.4) transthoracic echocardiography examinations. APACHE was 20.6 ± 7.3, 41% had positive blood cultures, >40% died within 4 months. On multivariate Cox survival analysis, the LV ejection fraction, end-diastolic volume and Em wave on tissue Doppler imaging independently predicted improved survival and the heart rate independently predicted worse survival (Exp(B) = 0.009, 0.969, 0.9, 1.004 and P < 0.0001, P < 0.0001, P = 0.001, P = 0.002, respectively). Only 45% of patients with end-diastolic volume index <40 ml survived more than 4 months, compared with 75% survival in patients with end-diastolic volume index >54 ml.
Decreased ejection fraction, decreased end-diastolic volume, diastolic dysfunction and tachycardia are independent predictors of early mortality in severe sepsis and septic shock.