Sepsis ve Septik Şoklu Hastalarda Biventriküler Sistolik Fonksiyonun Mortalite Üzerine Etkisi

Giriş: Bu çalışmanın amacı, sepsis veya septik şoklu hastalarda sol ventrikül (LV) ve sağ ventrikül (RV) sistolik performansını ve hastane içi mortalitede olası fonksiyonel değişikliği değerlendirmektir. Hastalar ve Yöntem: Çalışmaya sepsis veya septik şok tanısı alan ardışık 37 hasta dahil edildi. Tüm hastalara kapsamlı transtorasik ekokardiyografik inceleme yapıldı. Yoğun bakım ünitesinden taburcu edilen hastaların verileri hastanede ölen hastaların verileriyle karşılaştırıldı. Bulgular: On beş hasta (%40.5) hayatta kalırken, 22 hasta (%59.5) hastanede ölmüştür. BNP (p= 0.01) ve SOFA (p= 0.009) yanında CRP (p= 0.05) ve prokalsitonin (p= 0.03) gibi enflamatuvar belirteçlerin taburculuk veya ölüm öncesi düzeyleri açısından sağ kalan ve ölen gruplar arasında anlamlı fark saptanmıştır. Çalışma popülasyonunda EF değeri %50’nin altında olan iki hasta (%5.4) tespit edilmiştir. Sekiz hastada (%21.6) apikal segmentte hipokinezi, dört hastada (%10.8) 17 mm’nin altında TAPSE değerleri bulunmuştur. Sağ kalan grupta bir hastada (%6.6), ancak ölen gruptaki yedi hastada (%31.8) anlamlılığa doğru bir eğilim gösteren apikal hipokinezi belirlenmiştir (p= 0.068). Sağ kalan grupta bir hastada (%6.6) ve ölen grupta üç hastada (%13.6) RV sistolik disfonksiyonu saptanmıştır (p= 0.51). Sonuç: Sepsis veya septik şoklu hastalarda önceki çalışmalara göre çok daha düşük LV ve RV sistolik disfonksiyon oranı bulunmuştur. Miyokardiyal disfonksiyon tiplerinin hiçbiri hastane içi mortalite ile ilişkili saptanmamıştır. Apikal hipokinezi, sınırda önemli olmasına rağmen, hayatta kalmayanlarda daha yaygın bulunmuştur.

Impact of Bi-ventricular Systolic Function on Mortality in Patients with Sepsis and Septic Shock

Introduction: We aimed to evaluate left ventricular (LV) and right ventricular (RV) systolic performance in patients with sepsis or septic shock and possible functional alteration on in-hospital mortality. Patients and Methods: Thirty-seven consecutive patients with the diagnosis of sepsis or septic shock were included in the study. All patients underwent comprehensive transthoracic echocardiographic examination. Data of patients discharged from the intensive care unit was compared with data of patients who died in the hospital. Results: Fifteen patients (40.5%) survived, while 22 patients were died in the hospital (59.5%). A significant difference was detected between survivor and non-survivor groups regarding before discharge or death level of inflammatory markers such as CRP (p= 0.05) and procalcitonin (p= 0.03) besides BNP (p= 0.01) and SOFA (p= 0.009) score. There were two patients (5.4%) with EF value less than %50 in the study population. Eight patients (21.6%) displayed hypokinesia on the apical segment, and four patients (10.8%) had TAPSE values below 17 mm. One patient (6.6%) in the survivor group, but seven patients (31.8%) in the non-survivor group had apical hypokinesia with a trend towards significance (p= 0.068). One patient in the survivor group (6.6%) and three patients (13.6%) in the non-survivor group had RV systolic dysfunction (p= 0.51). Conclusion: We found a much lower rate of LV and RV systolic dysfunction in patients with sepsis or septic shock compared with previous studies. None of the myocardial dysfunction types was associated with in-hospital mortality. Apical hypokinesia was also more prevalent in non-survivors despite borderline significance.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi