Cardiac Dysfuction In Septic Patients And Its Impact On The Prognosis Of Sepsis

Objective: Sepsis has a high incidence in the intensive care unit,that is defined as the imbalance of the host response to infection,which can cause life-threatening organ dysfunction in sepsis-3,more emphasis on the importance of organ dysfunction.Sepsis can induce organ dysfunction including respiratory system,central nervous system,blood system,cardiovascular system and so on.Septic cardiac dysfunction is one of the most complex organs in cardiovascular system on the course of the disease,host reaction and dynamic adaptation of resuscitation.With the application of bedside echocardiography in intensive care units,many studies have described different types of cardiac dysfunction in sepsis.People only focused on left ventricular(LV)systolic dysfunction previously,which is now known to identify other types of myocardial dysfunction.As a part of heart failure,septic cardiac dysfunction may have different treatment options and may have an impact on the prognosis of patients,that includes left ventricular systolic dysfunction,left ventricular diastolic dysfunction,and right ventricular(RV)dysfunction.Various types of cardiac dysfunction may exist alone or in combination and are reversible during recovery.Although different types of cardiac dysfunction have been evaluated on some extent,but their definitions and clinical manifestations are lack of consensus,and The prognosis of patients with sepsis is not clear.In this study,we will observe the cardiac dysfunction by using transthoracic echocardiography in patients with sepsis and to its impact of the 28 days and 60 days mortality.Method: A prospective observational study was conducted in 53 patients with sepsis who were admitted to the emergency intensive care unit(EICU)of CangZhou Central Hospital of Hebei from January 1,2016 to December 31,2016.We gived the ICU patients the bedside echocardiography for the firsttime within 24 hours,to record the left ventricular ejection fraction and the three cusp systolic displacement(TAPSE),meanwhile to measure the ratio of the early diastolic peak velocity of mitral annulu by pulsed Doppler and the early diastolic velocity of mitral annulus by tissue Doppler(E/E,).At the same time,we recorded the general clinical data,physiological parameters including hemodynamic parameters and vasoactive dose,and calculated the APACHE II and SOFA score finally.According to the results of ultrasound,the patients were divided into normal cardiac function group and cardiac dysfunction group.And the cardiac dysfunction was further divided into left ventricular systolic dysfunction group,left ventricular diastolic dysfunction group and right ventricular dysfunction group.Finally,we calculated the incidence of various types of my dysfunction,and compared the differences of the demographic,hemodynamic,physiological variables,the mortality of28 day and 60 day in patients between normal cardiac fuction and cardiac dysfunction.Result: We enrolled 53 patients,the average age of 62±17 years,27 cases of male,female 26 cases.30 cases(57%)were able to record the microbial positive culture source,positive blood culture results of 10 cases accounted for 19%,other specimens including sputum,urine culture positive microbial source,drainage fluid,secretion of 20 cases(38%),18 cases(33%)were cultured and did not get a clear positive etiological results,5 cases(10%)due to various reasons without training.These patients included pulmonary infection(10),cholecystitis(3),liver abscess(3),bacteremia(4),soft tissue infection(7),digestive tract infection(7),urinary tract infection(3),epidemic hemorrhagic fever(2),nervous system infection(4),mixed infection(8),and the source of infection is not clear(2).The patients were divided into four groups according to the results of ultrasound:the normal group,the left ventricular systolic dysfunction group,the left ventricular diastolic dysfunction group and the right heart dysfunction group.Among them,the cardiac dysfunction is 34 cases,accounting for 64%of the total number,inciuding left ventricular systolic dysfunction in 14 cases(26%),left ventricular diastolic dysfunction in 20 cases(38%),and right ventricular dysfunction in 16 cases(30%).Patients with normal heart function in 19 patients(36%).Overlap between types of cardiac dysfunction,3 cases(6%)showed the presence of diastolic dysfunction associated with left ventricular and right ventricular systolic dysfunction,5 cases(9%)with biventricular systolic dysfunction but diastolic function of normal,2 cases(4%)had the left ventricular systolic and diastolic and right ventricular dysfunction,4 cases(8%)exist left ventricular and right ventricular dysfunction.A total of 19 patients(36%)died within 28 days,with 30 cases(57%)deaths within 60 days.The 28 day and the 60 day mortality rates of the normal cardiac function group and the cardiac dysfunction group were42%,32% and 53%,57% respectively(P=0.31vsP=0.83),there was no statistical significance.Conclusion:1 Cardiac dysfunction is common in sepsis,including left ventricular systolic dysfunction,left ventricular diastolic dysfunction and right ventricular dysfunction,that take the left ventricular ejection fraction(LVEF)as the only standard of evaluation of septic cardiac dysfunction has limitations.2 There was no significant difference in mortality between 28 days and60 days in patients with septic cardiac dysfunction and those with no cardiac dysfunction by bedside echocardiography.3 In the intensive care unit,the application of bedside echocardiography provides an important basis for the diagnosis,classification of septic cardiac dysfunction and interventions.