Prognostic impact of left ventricular diastolic function in patients with septic shock.

BACKGROUND: Left ventricular (LV) diastolic dysfunction is highly prevalent in the general population and associated with a significant morbidity and mortality. Its prognostic role in patients sustaining septic shock in the intensive care unit (ICU) remains controversial. Accordingly, we investigated whether LV diastolic function was independently associated with ICU mortality in a cohort of septic shock patients assessed using critical care echocardiography.

METHODS: Over a 5-year period, patients hospitalized in a Medical-Surgical ICU who underwent an echocardiographic assessment with digitally stored images during the initial management of a septic shock were included in this retrospective single-center study. Off-line echocardiographic measurements were independently performed by an expert in critical care echocardiography who was unaware of patients' outcome. LV diastolic dysfunction was defined by the presence of a lateral E' maximal velocity <10 cm/s. A multivariate analysis was performed to determine independent risk factors associated with ICU mortality.

RESULTS: Among the 540 patients hospitalized in the ICU with septic shock during the study period, 223 were studied (140 men [63 %]; age 64 ± 13 years; SAPS II 55 ± 18; SOFA 10 ± 3; Charlson 3.5 ± 2.5) and 204 of them (91 %) were mechanically ventilated. ICU mortality was 35 %. LV diastolic dysfunction was observed in 31 % of patients. The proportion of LV diastolic dysfunction tended to be higher in non-survivors than in their counterparts (28/78 [36 %] vs. 41/145 [28 %]: p = 0.15). Inappropriate initial antibiotic therapy (OR 4.17 [CI 95 % 1.33-12.5]: p = 0.03), maximal dose of vasopressors (OR 1.38 [CI 95 % 1.16-1.63]: p = 0.01), SOFA score (OR 1.16 [CI 95 % 1.02-1.32]: p = 0.02) and lateral E' maximal velocity (OR 1.12 [CI 95 % 1.01-1.24]: p = 0.02) were independently associated with ICU mortality. After adjusting for the SAPS II score, inappropriate initial antibiotic therapy and maximal dose of vasopressors remained independent factors for ICU mortality, whereas a trend was only observed for lateral E' maximal velocity (OR 1.11 [CI 95 % 0.99-1.23]: p = 0.07).

CONCLUSION: The present study suggests that LV diastolic function might be associated with ICU mortality in patients with septic shock. A multicenter prospective study assessing a large cohort of patients using serial echocardiographic examinations remains required to confirm the prognostic value of LV diastolic dysfunction in septic shock.