Incidence and course of early cardiac failure in long term ICU patients

Introduction

Cardiac failure is a potential motor of multiple organ failure in long term ICU patients [1]. The aim of our study was to monitor incidence on admission of cardiac failure in long term ICU patients. The early course (first 72 hours) of cardiac failure was also evaluated.

Materials and methods

ICU database was used for data acquisition. Long term patients were defined as those who survived > 3 days in the ICU. Cardiac failure was defined as cardiac SOFA points = 3.

Statistics

Chi-square, Fisher exact test, Mann-Whitney U-test and Manova for repeated measures when appropriate. Data are presented as means ± SD. P < 0.05 was considered significant.

Results

Out of 110 patients admitted from January 1 to October 15, 72 (65%) stayed in the ICU > 3 days. Forty-six patients (65%) survived and 26 died. Survivors (S) and non-survivors (NS) did not differ in age (55.2 ± 15.9 and 60.5 ± 15.9 years, respectively; P = 0.18). S had significantly higher APACHE II score on admission than NS (24.2 ± 7.2 and 29.2 ± 7.0, respectively; P < 0.01). S had significantly lower incidence of cardiac failure on admission (<24 hours) compared to NS (13 [28%] and 17 [65%], respectively, P < 0.001). This difference was attenuated but remained significant by day 2 when additional 5 S developed cardiac failure (8 developed, 3 recovered) and there was no change in NS (P < 0.05). Non-survivors had a trend to more severe forms (cardiac SOFA points 4) of cardiac failure in the first two days of hospitalisation (P = 0.1). The course of cardiac failure during the first 3 days of ICU stay did not differ between S and NS (Manova time effect P = 0.23). Only 2 survivors without cardiac failure during the first 48 hours (n = 25) developed cardiac failure during their further ICU stay (both later than 72 hours after admission).

Conclusions

Long term ICU patients who do not survive have greater incidence of cardiac failure on admission. Nevertheless the course of cardiac failure during the first 3 ICU days does not differentiate between survivors and non-survivors.