Abstract 15051: Left Ventricular Dilatation Improves Survival in Patients with Severe Sepsis
OBJECTIVE: The hallmark of sepsis-induced myocardial dysfunction is the development of acute left ventricular (LV) dysfunction, with a normal or increased cardiac output. This preservation of cardiac output may be the result of LV dilatation, a potentially adaptive response. Few human observational studies have reported variable incidence of such dilatation, and this has been associated with improved survival in a murine model. We sought to determine the potential association between LV end diastolic diameter (LVEDD) and survival in patients with severe sepsis.
METHODS: This is a nested case control study from a retrospective cohort analysis of hospitalized patients admitted for severe sepsis over a one year period at two tertiary hospitals of the Montefiore Medical Center, Bronx, New York. The inclusion criterion was patients admitted with severe sepsis based on the ICD-9 codes indicative of infection concurrent with new onset organ dysfunction who were admitted to an intensive care unit (ICU). The primary study outcome was 28-day all-cause mortality from the date of ICU admission. LVEDD was categorized as high (≥52mm) or low (<52mm). All statistical analyses were performed using Stata version 11.2.
RESULTS: Between January 1, 2007 and December 31, 2007, there were 73 (27.8%) patients with high LVEDD and 190 (72.2%) with low LVEDD. Patients with high LVEDD were younger (p=0.04) and more men (p<0.01). There was no difference in race (p=0.91), Mortality in Emergency Department Sepsis (MEDS) score (p=0.81), APACHE II score (p=0.47), Charlson’s score (p=0.48) and foci of infection (p>0.05) among groups. The crude 28-day all-cause mortality was 21.9% in the high LVEDD group and 29.0% in the low LVEDD group (p=0.28). In the adjusted analysis, the 28-day all-cause mortality was associated with MEDS score (HR 1.06 [95% C.I. 1.01-1.12]), depressed ejection fraction (HR 1.58 [95% C.I. 1.22-2.05]) and high LVEDD (HR 0.50 [95% C.I. 0.26-0.94]) after adjusting for age, gender, APACHE II and Charlson’s score.
CONCLUSIONS: In critically ill patients with severe sepsis, high LVEDD, defined as 52 mm or greater, was independently associated with a 28-day survival benefit.
- © 2012 by American Heart Association, Inc.