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Risk factors and outcomes of sepsis-induced myocardial dysfunction and stress-induced cardiomyopathy in sepsis or septic shock: A comparative retrospective study.

Abstract While both sepsis-induced myocardial dysfunction (SIMD) and stress-induced cardiomyopathy (SICMP) are common in patients with sepsis, the pathogenesis of the 2 diseases is different, and they require different treatment strategies. Thus, we aimed to investigate risk factors and outcomes between the 2 diseases.This retrospective study enrolled patients diagnosed with sepsis or septic shock, admitted to intensive care unit via emergency department in Korea University Anam Hospital, and who underwent transthoracic echocardiography within the first 24 hours of admission.In all, 25 patients with SIMD and 27 patients with SICMP were enrolled. Chronic obstructive pulmonary disease and a history of heart failure (HF) were more prevalent in both the SIMD and SICMP groups than in the control group. In the SIMD and SICMP groups, levels of inflammatory cytokines were similar. Serum troponin level was significantly elevated in the SICMP and SIMD group compared to the control group. N-terminal pro-brain natriuretic peptide (NT pro-BNP) level was significantly elevated in the SIMD group compared to the SICMP group or control group. The in-hospital mortality rate in the SIMD and SICMP group was about 40%, showing increased trends compared with the control group. The in-hospital mortality rate was significantly increased in SIMD group with EF<30% than in SICMP group with EF<30%. In multiple logistic regression analysis, a past history of diabetes mellitus (DM) and HF was significantly associated with the incidence of SIMD. Younger age, elevated levels of NT pro-BNP, and positive result of blood culture also showed significant odds ratio regard to the occurrence of SIMD. However, only elevated lactate and troponin level were positively associated with the incidence of SICMP.The SIMD and SICMP had different risk factors. The risk factors of SIMD were younger age, history of DM, history of HF, elevated NT pro-BNP, and positive result of blood culture. The elevated levels of lactate and troponin were identified as risk factors of SICMP. More importantly, in-hospital mortality rate from SIMD and SICMP showed increased trend and worse outcome in SIMD group with reduced EF<30%. Thus, developing SIMD or SICMP reflected poor prognosis in sepsis or septic shock.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29595686
OWN - NLM
STAT- MEDLINE
DCOM- 20180411
LR  - 20180411
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 13
DP  - 2018 Mar
TI  - Risk factors and outcomes of sepsis-induced myocardial dysfunction and
      stress-induced cardiomyopathy in sepsis or septic shock: A comparative
      retrospective study.
PG  - e0263
LID - 10.1097/MD.0000000000010263 [doi]
AB  - While both sepsis-induced myocardial dysfunction (SIMD) and stress-induced
      cardiomyopathy (SICMP) are common in patients with sepsis, the pathogenesis of
      the 2 diseases is different, and they require different treatment strategies.
      Thus, we aimed to investigate risk factors and outcomes between the 2
      diseases.This retrospective study enrolled patients diagnosed with sepsis or
      septic shock, admitted to intensive care unit via emergency department in Korea
      University Anam Hospital, and who underwent transthoracic echocardiography within
      the first 24 hours of admission.In all, 25 patients with SIMD and 27 patients
      with SICMP were enrolled. Chronic obstructive pulmonary disease and a history of 
      heart failure (HF) were more prevalent in both the SIMD and SICMP groups than in 
      the control group. In the SIMD and SICMP groups, levels of inflammatory cytokines
      were similar. Serum troponin level was significantly elevated in the SICMP and
      SIMD group compared to the control group. N-terminal pro-brain natriuretic
      peptide (NT pro-BNP) level was significantly elevated in the SIMD group compared 
      to the SICMP group or control group. The in-hospital mortality rate in the SIMD
      and SICMP group was about 40%, showing increased trends compared with the control
      group. The in-hospital mortality rate was significantly increased in SIMD group
      with EF&lt;30% than in SICMP group with EF&lt;30%. In multiple logistic regression
      analysis, a past history of diabetes mellitus (DM) and HF was significantly
      associated with the incidence of SIMD. Younger age, elevated levels of NT
      pro-BNP, and positive result of blood culture also showed significant odds ratio 
      regard to the occurrence of SIMD. However, only elevated lactate and troponin
      level were positively associated with the incidence of SICMP.The SIMD and SICMP
      had different risk factors. The risk factors of SIMD were younger age, history of
      DM, history of HF, elevated NT pro-BNP, and positive result of blood culture. The
      elevated levels of lactate and troponin were identified as risk factors of SICMP.
      More importantly, in-hospital mortality rate from SIMD and SICMP showed increased
      trend and worse outcome in SIMD group with reduced EF&lt;30%. Thus, developing SIMD 
      or SICMP reflected poor prognosis in sepsis or septic shock.
FAU - Jeong, Han Saem
AU  - Jeong HS
AD  - Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital.
FAU - Lee, Tae Hyub
AU  - Lee TH
AD  - College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
FAU - Bang, Cho Hee
AU  - Bang CH
AD  - Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital.
FAU - Kim, Jong-Ho
AU  - Kim JH
AD  - Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital.
FAU - Hong, Soon Jun
AU  - Hong SJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Biomarkers)
RN  - 0 (Cytokines)
RN  - 0 (Inflammation Mediators)
RN  - 0 (Peptide Fragments)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 33X04XA5AT (Lactic Acid)
SB  - AIM
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Biomarkers
MH  - Comorbidity
MH  - Cytokines/metabolism
MH  - Diabetes Mellitus/epidemiology
MH  - Echocardiography
MH  - Female
MH  - Heart Failure/epidemiology/*etiology
MH  - Hospital Mortality
MH  - Humans
MH  - Inflammation Mediators/metabolism
MH  - Intensive Care Units
MH  - Lactic Acid/blood
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/blood
MH  - Odds Ratio
MH  - Peptide Fragments/blood
MH  - Pulmonary Disease, Chronic Obstructive/epidemiology
MH  - Republic of Korea
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sepsis/*complications/*epidemiology
MH  - Shock, Septic/complications/epidemiology
MH  - Takotsubo Cardiomyopathy/*epidemiology
EDAT- 2018/03/30 06:00
MHDA- 2018/04/12 06:00
CRDT- 2018/03/30 06:00
PHST- 2018/03/30 06:00 [entrez]
PHST- 2018/03/30 06:00 [pubmed]
PHST- 2018/04/12 06:00 [medline]
AID - 10.1097/MD.0000000000010263 [doi]
AID - 00005792-201803300-00059 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Mar;97(13):e0263. doi: 10.1097/MD.0000000000010263.