Negoiţă, Silvius

Introduction: Sepsis-induced cardiac dysfunction (SICD) is a reversible type of cardiac disorder, with variable reported incidence and uncertain prognostic implications that may occur in patients with sepsis. This study aimed to identify patients with SICD, characterise their clinical and paraclinical features, analyse the different patterns of cardiac dysfunction, and determine prognostic implications. Methods: Patients admitted to the intensive care unit (ICU) for sepsis or septic shock who underwent echocardiography on admission were identified retrospectively. Exclusion criteria included acute myocardial infarction, preexisting severe left heart valve disease or systolic dysfunction. Clinical, paraclinical, and echocardiography data were documented. The primary outcome was a composite of in-hospital mortality, prolonged hospital stay, and prolonged ICU stay. Results: A total of 128 septic patients were included, with a median age of 72.5 years and a 55% male proportion. Alcohol abuse, vasopressor therapy and orotracheal intubation on admission were risk factors for developing SICD. More than a third developed SICD (37%). We identified four different types of cardiac dysfunction based on echocardiography. An NT-proBNP level of over 9000 pg/mL was a predictor of SICD, composite outcome and mortality. A total of 56 patients (44%) experienced in-hospital mortality. Even though the occurrence of SICD did not predict mortality, it was a significant predictor of the composite outcome. Conclusions: This study describes the incidence and spectrum of SICD in a group of septic patients admitted to a tertiary care hospital. The occurrence of any type of cardiac dysfunction associated with sepsis and high NT-proBNP levels had strong prognostic implications.

Introduction: Sepsis-induced cardiac dysfunction (SICD) is a transient cardiac disfunction, with variable described prevalence and uncertain prognostic. This study aimed to characterize the laboratory and microbiological findings in critically ill patients with sepsis who developed left ventricular (LV) or biventricular systolic dysfunction. Methods: Patients who required intensive care unit hospitalization for sepsis were screened retrospectively. Only patients with positive cultures and echocardiography performed within 24 h from admission were included. The exclusion criteria were infective endocarditis, acute coronary syndrome, history of cardiomyopathy, severe valve disease, end-stage organ or oncological disease. Cardiac function was appreciated on transthoracic echocardiography, using LV ejection fraction for the left ventricle and tricuspid annular plane systolic excursion (TAPSE) for the right ventricle. SICD was confirmed if the systolic dysfunction found upon admission was reversible within 7–10 days. Results: A total of 100 patients with positive cultures were included. The median age was 73 and 55% were male. SICD was diagnosed in 14% of patients. Patients with SICD were more likely to develop septic shock and had longer hospital and intensive care unit stay. In-hospital mortality was 44% with no significant difference between SICD and non-SICD patients. Laboratory markers upon hospital admission showed that SICD patients had significantly higher values of lactate and transaminases. Cardiac (troponin and NT-proBNP) and inflammation markers (leukocytes, neutrophils, NLR, C-reactive protein, procalcitonin) had higher values in patients with SICD but the difference did not reach statistical significance. Streptococcal infections and polymicrobial cultures were risk factors for developing SICD. Higher rates of infections with Enterobacterales were seen in the SICD group but the difference was not significant. Conclusions: SICD patients had higher lactate, inflammation, and cardiac biomarkers levels upon admission and significantly higher rates of streptococcal infections and polymicrobial cultures.