Haemodynamic alterations in community-acquired sepsis at early stage

Introduction

Community-acquired sepsis at an early stage is common, but haemodynamic alterations remain unclear. The aim of the study was to characterize cardiovascular alterations in patients of our ProFS (monocentric observational) study, which was to characterize patients with sepsis in the emergency department.

Methods

Systemic vascular resistance (SVR) and cardiac output (CO) were measured non-invasively using a TaskForce monitor (CNSystems, Graz, Austria) after admission, 24 hours and 72 hours. Indexed values were calculated (SVRI (dyn·second/cm⁵/m²), CI (l/minute/m²)). Procalcitonin (PCT, ng/ml) was measured in serum.

Results

A sample of 64 patients of 208 included patients received haemodynamic examination. Mean age was 61.8 ± 18.0 years, 62.7% were male. Patients were divided by PCT <2 and ≥2. Age, gender and previous medical history were comparable in both groups. The heart rate was 99.8 ± 21.6 vs 104.6 ± 23.0/minute (P = NS) and the mean artery pressure was 89.5 ± 15.6 vs 81.6 ± 21.5 mmHg (P < 0.01). Mean SVRI in patients with PCT <2 was 2,934 ± 1,045 vs 2,376 ± 842, P < 0.05 at the time of admission. No difference was found after 24 hours (2,959 ± 1,002 vs 2,924 ± 1,324, P = NS) and 72 hours (3,123 ± 931 vs 3,556 ± 1,524, P = NS). On the contrary, for patients with PCT ≥2 the increase after 72 hours was significant (P < 0.05). Differences after admission could not be observed for CI between patients with PCT <2 vs ≥2. Mean values after admission were 2.7 ± 1.0 vs 2.8 ± 0.8, after 24 hours 2.5 ± 0.8 vs 2.5 ± 0.5, and after 72 hours 2.3 ± 0.7 vs 2.3 ± 0.6 (all: P = NS). See Figure 1

Figure 1

Systemic vascular resistance index and cardiac index in sepsis in the emergency department.

Conclusions

Patients with community-acquired sepsis in the emergency department had an elevated SVRI. At the time of admission patients with high PCT had a significantly lower SVRI than patients with low PCT. Cardiac index at the time of admission was at a lower limit of normal range in all patients. These findings are in strong contrast to the classic pattern of sepsis on the ICU, where SVRI is keenly reduced and CI elevated. They implicate that patients with sepsis in the emergency department may benefit more from application of fluid and positive inotrope substances than from vasopressor.