Association Between Initial Left Ventricular Systolic Dysfunction and Clinical Outcome in Sepsis: A Multicenter Cohort Study.

IF 6 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2025-07-02 DOI:10.1097/CCM.0000000000006771

Hyunseung Nam, Ji Hyun Cha, Ki Hong Choi, Chi Ryang Chung, Jeong Hoon Yang, Gee Young Suh, Sunghoon Park, Chae-Man Lim, Ryoung-Eun Ko

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Abstract

Objectives: To investigate the association between the severities of left ventricular (LV) systolic dysfunction and clinical outcomes in patients with sepsis, with a particular focus on in-hospital mortality.

Design: Multicenter cohort study.

Setting: Nineteen tertiary or university-affiliated hospitals in South Korea.

Patients: A total of 2274 adult patients with sepsis or septic shock underwent echocardiographic examination within 24 hours of sepsis recognition.

Interventions: None.

Measurements and main results: Patients were stratified by left ventricular ejection fraction (LVEF) into three groups: normal (> 50%, n = 1803), mild-to-moderate dysfunction (30-50%, n = 356), and severe dysfunction (< 30%, n = 115). In-hospital mortality is significantly associated with LV dysfunction severity (normal: 25.73%, mild-to-moderate: 29.49%, severe: 40.00%; p = 0.023). After propensity score matching using three different methodologies, severe LV dysfunction remained independently associated with increased in-hospital mortality (adjusted odds ratio [OR] 1.81; 95% CI, 1.09-3.03). This effect was more pronounced in patients without preexisting cardiovascular disease (CVD) (OR 1.84; 95% CI, 1.08-3.13) and those with bacteremia (OR 2.20; 95% CI, 1.5-3.22). Cardiopulmonary arrest rates increased significantly with dysfunction severity (normal: 2.11%, mild-to-moderate: 3.93%, severe: 10.43%; p < 0.001), while other ICU complications showed no significant differences.

Conclusions: Severe LV systolic dysfunction (LVEF < 30%) is associated with significantly increased in-hospital mortality in sepsis patients, particularly in those with bacteremia and without preexisting CVD. These findings highlight the importance of early cardiac function assessment in sepsis and suggest that infection status and underlying cardiovascular health modify the relationship between LV dysfunction and clinical outcome.

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脓毒症患者初始左心室收缩功能障碍与临床结局的关系：一项多中心队列研究。

目的：探讨脓毒症患者左心室（LV）收缩功能障碍严重程度与临床结局之间的关系，特别关注住院死亡率。设计：多中心队列研究。地点：韩国19所三级医院或大学附属医院。患者：共有2274例成年脓毒症或感染性休克患者在脓毒症识别后24小时内接受超声心动图检查。干预措施:没有。测量和主要结果：根据左室射血分数（LVEF）将患者分为正常（50%,n = 1803）、轻中度功能障碍（30-50%,n = 356）和重度功能障碍（< 30%,n = 115）三组。住院死亡率与左室功能障碍严重程度显著相关(正常：25.73%，轻中度：29.49%，重度：40.00%；P = 0.023)。在使用三种不同的方法进行倾向评分匹配后，严重的左室功能障碍仍然与住院死亡率增加独立相关(调整优势比[OR] 1.81；95% ci, 1.09-3.03)。这种效应在没有既往存在心血管疾病（CVD）的患者中更为明显(OR 1.84；95% CI, 1.08-3.13)和菌血症患者(OR 2.20；95% ci, 1.5-3.22)。随着功能障碍严重程度的增加，心肺骤停率明显增高(正常：2.11%，轻中度：3.93%，重度：10.43%；p < 0.001)，其他ICU并发症无显著差异。结论：严重左室收缩功能障碍（LVEF < 30%）与脓毒症患者住院死亡率显著增加相关，特别是那些伴有菌血症且未存在心血管疾病的患者。这些发现强调了早期心功能评估在败血症中的重要性，并表明感染状态和潜在的心血管健康改变了左室功能障碍与临床结果之间的关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.