Τετάρτη, 17 Ιουλίου 2019


Right ventricular function and long-term outcome in sepsis: a retrospective cohort study,

Background: Sepsis-related myocardial dysfunction is associated with impaired outcome. Traditionally, in this setting the main focus has been on left ventricular performance. Currently, specific knowledge on the prognostic importance of right ventricular dysfunction is scarce. The aim of this study was to determine whether right ventricular ejection fraction (RVEF) is predictive of long-term mortality in sepsis. Methods: Single-centre retrospective cohort study in adult patients admitted to the ICU with severe sepsis and septic shock, and equipped with a pulmonary artery catheter within the first day following admission. RVEF was recorded as an average over the first 24 hours (sample rate of 1 per minute). Patients were separated a priori into subgroups according to their RVEF: RVEF < 20% (A), RVEF 20–30% (B), and RVEF>30% (C). The primary endpoint was one-year all-cause mortality. Results: In a 7-year period, 101 patients fulfilled all entry criteria and 98 were included in the study. One-year all-cause mortality was significantly different between groups: 57% in group A (n = 21), 18% in group B (n = 55), and 23% in group C (n = 22); p = 0.003. Kaplan-Meier survival analysis revealed a clear separation between group A and B/C (X2 = 14.00, p = 0.001). In a multivariate logistic regression analysis RVEF, both as a categorical variable (RVEF < 20%) and as a continuous variable, remained independently associated with the primary endpoint (OR 4.1; 95% CI 1.3–13.4; p = 0.018 and OR 0.92; 95% CI 0.85–0.99; p = 0.018 respectively). Conclusion: RVEF was independently associated with one-year all-cause mortality in a highly selected group of patients with severe sepsis and septic shock. Address reprint requests to Jurgen C. Winkelhorst, Department of Intensive Care, Medical Centre Leeuwarden, Henri Dunantweg 2, P.O. Box 888, 8901 BR Leeuwarden, The Netherlands. E-mail: jurgenwinkelhorst@gmail.com Received 8 May, 2019 Revised 10 July, 2019 Accepted 10 July, 2019 Funding: Not applicable. Conflict of interest: The authors have no conflicts of interest. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.shockjournal.com). © 2019 by the Shock Society

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