Both systolic and diastolic functions are impaired in critically ill patients with community-acquired sepsis

Introduction

Alterations in haemodynamic parameters in septic cardiomyopathy are usual. While patients with APACHE II score <15 have a low risk of death, patients with score ≥15 have one of >25%. In a subgroup of our monocentric observational ProFS study (depiction of patients with community-acquired sepsis in the emergency department), systolic and diastolic function were evaluated concerning patients risk of death.

Methods

Echocardiographic examination was performed at admission, after 24 and 72 hours. The left ventricular systolic ejection fraction (EF, %) was measured using Simpson's rule, and early peak diastolic relaxation velocity of septal mitral annulus (E', cm/second) was measured using tissue Doppler imaging. APACHE II score was calculated at admission. By APACHE II score, two groups were formed: low APACHE II score (LAS) was defined as 0 to 14 patients and high APACHE II score (HAS) ≥15 patients.

Results

In 65 of 208 patients an echocardiographic examination was performed. Age (61.0 ± 18.4 vs 63.5 ± 16.9 years, P = NS), male sex (64.5% vs 58.8%, P = NS) and mean artery pressure (86.2 ± 15.7 vs 85.7 ± 21.2 mmHg, P = NS) were comparable, whereas patients with HAS had a higher heart rate (96.5 ± 24.5 vs 108.2 ± 17.1/minute, P < 0.05). At admission, patients with HAS had a significantly lower EF than patients with LAS (55.1 ± 7.0 vs 50.5 ± 10.1, P < 0.05). Difference could not be observed after 24 hours (53.6 ± 7.2 vs 52.4 ± 7.%, P = NS) and 72 hours (53.8 ± 7.3 vs 54.3 ± 7.3, P = NS); see Figure 1. Patients with HAS showed a lower initial E' than patients with LAS (6.2 ± 2.1 vs 5.1 ± 2.1, P < 0.05) and after 24 hours (6.1 ± 2.2 vs 5.1 ± 1.3, P < 0.05). Three days after admission, E' values in patients with LAS and HAS were comparable (5.6 ± 2.0 vs 5.7 ± 2.1, P = NS).

Figure 1

Systolic and diastolic function indices in sepsis. n.s., not significant.

Conclusions

In patients with community-acquired sepsis and APACHE II score ≥15 points, a significantly depression of both systolic and diastolic function could be observed. After 24 hours systolic function and after 72 hours diastolic function of patients with an APACHE II score <15 and ≥15 points were similar. This could be possibly due to alterations in afterload.