Hemodynamic Changes, Organ Dysfunction, and Clinical Outcomes in Patients with Sepsis-Induced Myocardial Dysfunction.

Abstract

Objective: This study aims to investigate the hemodynamic changes associated with sepsis-induced myocardial dysfunction (SIMD), assess its impact on organ dysfunction, and evaluate its clinical outcomes.

Methods: A cohort of 170 patients with sepsis hospitalized at the First Hospital of Kunming were included and categorized into two groups: Group A (sepsis without myocardial dysfunction, n = 106) and Group B (SIMD, n = 64). The groups were compared with respect to hemodynamic parameters, organ dysfunction, and clinical outcomes.

Results: Patients in Group B were older and had higher acute physiology and chronic health evaluation II scores, central venous pressure, and dp/dt max, as well as elevated biomarker levels indicative of myocardial dysfunction, compared to those in Group A. The incidence of multiple organ dysfunction was significantly higher in Group B (all p < 0.05). Additionally, Group B exhibited prolonged mechanical ventilation duration, extended intensive care unit stays, and increased mortality rates. Multivariate analysis identified APACHE II scores (at days 1 and 7), troponin I (TnI), and B-type natriuretic peptide (BNP) as independent risk factors for septic shock in patients with SIMD. BNP demonstrated the highest area under the curve for predicting septic shock in this population, with an optimal cutoff value of 268 pg/mL (sensitivity 71.9%, specificity 80.2%, 95% CI 0.714-0.861).

Conclusion: SIMD is associated with significant hemodynamic disturbances, increased respiratory dysfunction, prolonged mechanical ventilation and hospitalization, and elevated mortality. BNP and cTnI levels were significantly elevated in patients with SIMD, indicating a heightened risk of septic shock and multiorgan dysfunction, leading to adverse clinical outcomes.