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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Article info
Publication history
Published online: December 13, 2019
Accepted:
November 26,
2019
Received in revised form:
November 25,
2019
Received:
August 24,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
