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Impact of left ventricular dysfunction and fluid balance on the outcomes of patients with sepsis

Published:December 13, 2019DOI:https://doi.org/10.1016/j.ejim.2019.11.019

      Highlights

      • We assessed whether the impact of LV dysfunction depends on fluid balance in sepsis.
      • AKI was prevalent in the patients with diastolic and systolic dysfunction.
      • Diastolic and systolic dysfunction were associated with longer duration of RRT.
      • Diastolic and systolic dysfunction were associated with mortality.
      • Their associations were independent of daily fluid balance.

      Abstract

      Objective

      Left ventricular (LV) dysfunction is a predictor of mortality in patients with sepsis. However, whether the adverse impact of LV dysfunction depends on fluid balance remains unclear. We retrospectively investigated the impact of LV dysfunction and fluid balance on various outcomes of patients with sepsis.

      Methods

      Critically ill patients with sepsis were classified according to their LV function: normal LV function, diastolic dysfunction (septal e′ of <10 and E/e′ of ≥15 with ejection fraction of ≥50%), and systolic dysfunction (ejection fraction of <50%).

      Results

      There were 83 (51.2%) patients with normal LV function, 39 (24.1%) with diastolic dysfunction, and 40 (24.7%) with systolic dysfunction. The cumulative and daily fluid balances after intensive care unit admission did not differ. However, acute kidney injury was more prevalent in the patients with diastolic and systolic dysfunction than in those with normal LV function (82.1%, 87.5%, and 69.9%, respectively; P = 0.065). LV dysfunction lengthened the duration of renal replacement therapy, independent of baseline renal dysfunction and the daily fluid balance (P = 0.008). Moreover, both diastolic and systolic dysfunction were associated with mortality (hazard ratio: 2.7 and 3.0; P = 0.047 and P = 0.028, respectively), regardless of the daily fluid balance, which was also a significant predictor of mortality (P < 0.001).

      Conclusions

      LV dysfunction has an adverse impact on renal outcomes and mortality in patients with sepsis and seems to be independent of fluid balance. Additional therapeutic options to restore organ perfusion are needed for patients with sepsis who have LV dysfunction, in addition to intravenous fluid restriction.

      Keywords

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