Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study
Issue 2 (2022) , INTENSIVE CARE OF SEPSIS
Issue 2 (2022)
INTENSIVE CARE OF SEPSIS

Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study

https://doi.org/10.21320/1818-474X-2022-2-70-79
Published 29.04.2022
Igor A. Kozlov
Moscow Regional Research and Clinical Institute, Moscow, Russia
https://orcid.org/0000-0003-1910-0207
A.M. Ovezov
Moscow Regional Research and Clinical Institute, Moscow, Russia
https://orcid.org/0000-0001-7629-6280
S.A. Rautbart
Moscow Regional Research and Clinical Institute, Moscow, Russia; Bujanov Moscow City Clinical Hospital, Moscow, Russia
https://orcid.org/0000-0001-8833-3886
I.N. Tyurin
City Clinical Hospital No 40, Moscow, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-5696-1586
A.A. Aleksandrovskiy
Bujanov Moscow City Clinical Hospital, Moscow, Russia
https://orcid.org/0000-0001-9848-3554
Yu.V. Skripkin
Moscow Regional Research and Clinical Institute, Moscow, Russia
https://orcid.org/0000-0002-6747-2833
#2022-2
PDF_2022-2_70-79 (Русский)
HTML_2022-2_70-79 (Русский)

Keywords

sepsis
organ dysfunction scores
risk factors
mortality
thermodilution
hemodynamic monitoring
cardiac output

How to Cite

Kozlov I.A., Ovezov A.M., Rautbart S.A., Tyurin I.N., Aleksandrovskiy A.A., Skripkin Y.V. Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study. Annals of Critical Care. 2022;(2):70–79. doi:10.21320/1818-474X-2022-2-70-79.
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver AMA GOST

Download Citation

Endnote/Zotero/Mendeley (RIS) BibTeX

Statistic

Abstract Views: 30
PDF_2022-2_70-79 (Русский) Downloads: 9
HTML_2022-2_70-79 (Русский) Downloads: 13
Statistic from 21.01.2023

Language

English Русский

Announcements

Social Networks

Abstract

OBJECTIVES. To analyze the predictive significance of clinical and laboratory parameters in relation to the risk of mortality, the assessment of which is available in the first 24 hours of the stay of patients with sepsis in the intensive care unit (ICU), and to assess the feasibility of starting invasive monitoring of central hemodynamics in patients with predictors of poor outcome. MATERIALS AND METHODS. We analyzed the results of examination of 134 patients aged 58.5 (43–71) years with abdominal sepsis. APACHE II score was 13 (11–17) points, SOFA score was 6 (4–8) points; l lethality in ICU — 47 %. Central hemodynamics was studied using transpulmonary thermodilution. Descriptive statistics (data are presented as median, 25 and 75 % quartiles), logistic regression and ROC analysis were used. RESULTS. Independent predictors of death were SOFA score > 8 (OR 1.5712; 95% CI 1.1934–2.0686; p = 0.0001; AUC 0.813; sensitivity 74 %, specificity 81 %) and lactateemia > 1.8 mmol/l (OR 3.5293; 95% CI 1.7421–7.1500; p = 0.0001; AUC 0.799; sensitivity 63 %, specificity 79 %). A combination of established risk factors predicted cardiac index < 2.5 l/min/m2 (OR 37.0; 95% CI 3.9167–349.5290; p = 0.002) and cardiac function index < 5.8 min-1 (OR 11.8182; 95% CI 2.8189–49.5303; p = 0.0007). CONCLUSIONS. Among the clinical and laboratory parameters, the assessment of which is available in the first 24 hours of the stay of patients with sepsis in the ICU, significant predictors of lethal outcome are SOFA score > 8 points and lactateemia > 1.8 mmol/l. Most patients with a combination of these risk factors are characterized by the presence of signs of myocardial dysfunction, and for 50 % — a decrease in CI to a level of < 2.5 l/min/m2, which indicates the advisability of invasive monitoring of central hemodynamics, in particular with transpulmonary thermodilution.

https://doi.org/10.21320/1818-474X-2022-2-70-79
PDF_2022-2_70-79 (Русский)
HTML_2022-2_70-79 (Русский)

References

  1. Virág M., Leiner T., Rottler M., et al. Individualized Hemodynamic Management in Sepsis. J Pers Med. 2021; 11(2): 157. DOI: 10.3390/jpm11020157
  2. Evans L., Rhodes A., Alhazzani W., et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021; 47(11): 1181–247. DOI: 10.1007/s00134-021-06506-y
  3. Ritter S., Rudiger A., Maggiorini M. Transpulmonary thermodilution derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study. Crit Care. 2009; 13(4): R133–R143. DOI: 10.1186/cc7994
  4. Cecconi M., Hernandez G., Dunser M., et al. Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force. Intensive Care Med. 2019; 45(1): 21–32. DOI: 10.1007/s00134-018-5415-2
  5. Тюрин И.Н., Раутбарт С.А., Ганиева И.И. и др. Прикроватная эхокардиография и транспульмональная термодилюция у больных с сепсисом. Пилотное исследование. Вестник интенсивной терапии им. А.И. Салтанова. 2020; 4: 108–19. DOI: 21320/1818-474X-2020-4-108-119 [Tyurin I.N., Rautbart S.A. Ganieva I.I., et al. Сritical care echocardiography and transpulmonary thermodilution in patients with sepsis. Pilot study. Annals of Critical Care. 2020; 4: 108–19. DOI: 10.21320/1818-474X-2020-4-108-119 (In Russ)]
  6. Werdan K., Oelke A., Hettwer S., et al. Septic cardiomyopathy: hemodynamic quantification, occurrence, and prognostic implications. Clin. Res. 2011; 100(8): 661–8. DOI: 10.1007/s00392-011-0292-5
  7. Раутбарт С.А., Тюрин И.Н., Александровский А.А., Козлов И.А. Индекс функции сердца как возможный целевой показатель для коррекции гемодинамики при абдоминальном сепсисе (пилотное исследование). Общая реаниматология. 2021; 17(5): 9–22. DOI: 10.15360/1813-9779-2021-5-9-22 [Rautbart S.A., Tyurin I.N., Aleksandrovskiy A.A., Kozlov I.A. Cardiac Function Index as a Possible Target Parameter Hemodynamic Correction in Abdominal Sepsis (Pilot Study) 2021; 17(5): 9–22. DOI: 10.15360/1813-9779-2021-5-9-22 (In Russ)]
  8. Lee E.P., Hsia S.H., Lin J.J., et al. Hemodynamic Analysis of Pediatric Septic Shock and Cardiogenic Shock Using Transpulmonary Thermodilution. Biomed Res Int. 2017; 2017: 3613475. DOI: 10.1155/2017/3613475
  9. Singer M., Deutschman C.S., Seymour C.W., et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). 2016; 315(8): 801–10. DOI: 10.1001/jama.2016.0287
  10. Баутин А.Е., Ксендикова А.В., Белолипецкий С.С. и др. О возможности использования фармакологических индексов для прогнозирования течения послеоперационного периода кардиохирургических вмешательств. Вестник интенсивной терапии имени А.И. Салтанова. 2019; 2: 66–74. DOI: 10.15360/1813-9779-2021-5-9-22 [Bautin A.E., Ksendikova A.V., Belolipetskiy S.S., et al. About efficiency of the pharmacological scores as a predictors of outcomes after cardiac surgery. Alexander Saltanov Intensive Care Herald. 2019; 2: 66–74. DOI: 10.21320/1818-474X-2019-2-66-74 (In Russ)]
  11. Кузьков В.В., Киров М.Ю. Инвазивный мониторинг гемодинамики в интенсивной терапии и анестезиологии. Архангельск: Северный гос. мед. ун-т, 2015. [Kuz’kov V.V., Kirov M.Yu. Invazivnyj monitoring gemodinamiki v intensivnoj terapii i anesteziologii. Arhangel’sk: Severnyj gos. med. un-t, 2015. (In Russ)]
  12. Fleischmann-Struzek C., Mellhammar L., Rose N., et al. Incidence and mortality of hospital- and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. Intensive Care Med. 2020; 46(8): 1552–62. DOI: 10.1007/s00134-020-06151-x
  13. Greenwood J.C., Orloski C.J. End points of sepsis resuscitation. Med. Clin. North Am. 2017; 35(1): 93‒107. DOI: 10.1016/j.emc.2016.09.001
  14. Egi1 M., Ogura H., Yatabe T., et al. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). Acute Med Surg. 2021; 8(1): e659. DOI: 10.1002/AMS2.659
  15. Beesley S.J., Weber G., Sarge T., et al. Septic Cardiomyopathy. Crit Care Med. 2018; 46(4): 625–34. DOI: 10.1097/CCM.0000000000002851
  16. Nizamuddin J., Mahmood F., Tung A., et al. Interval Changes in Myocardial Performance Index Predict Outcome in Severe Sepsis. J Cardiothorac Vasc Anesth. 2017; 31(3): 957–64. DOI: 10.1053/j.jvca.2016.11.007
  17. Sevilla Berrios R.A., O’Horo J.C., Velagapudi V., Pulido J.N. Correlation of left ventricular systolic dysfunction determined by low ejection fraction and 30-day mortality in patients with severe sepsis and septic shock: a systematic review and meta-analysis. J. Crit Care. 2014; 29(4): 495– DOI: 10.1016/j.jcrc.2014.03.007
  18. Sato R., Ariyoshi N., Hasegawa D., et al. Effects of Inotropes on the Mortality in Patients With Septic Shock. J Intensive Care Med. 2021; 36(2): 211–9. DOI: 10.1177/0885066619892218
  19. Козлов И.А., Тюрин И.Н., Раутбарт С.А. Ранние гемодинамические предикторы летального исхода абдоминального сепсиса. Вестник анестезиологии и реаниматологии. 2018; 15(2): 6–15. DOI:21292/2078-5658-2018-15-2-6-15 [Kozlov I.A., Tyurin I.N., Rautbart S.A. Early hemodynamic predictors of lethal outcomes of abdominal sepsis. Vestnik anesteziologii i reanimatologii. 2018; 15(2): 6–15. DOI: 10.21292/2078-5658-2018-15-2-6-15 (In Russ)]
  20. Тюрин И.Н., Раутбарт С.А., Проценко Д.Н. и др. Биомаркер напряжения миокарда NT-proBNP у больных с абдоминальным сепсисом и септическим шоком. Патология кровообращения и кардиохирургия. 2020; 24(1): 65–77. DOI:21688/1681-3472-2020-1-65-77 [Tyurin I.N., Rautbart S.A., Protsenko D.N., et al. N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2020; 24(1): 65–77. DOI: 10.21688/1681-3472-2020-1-65-77 (In Russ)]
  21. Vincent J.L., Moreno R., Takala J., et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22(7): 707–10. DOI: 10.1007/BF01709751
  22. Заболотских И.Б., Мусаева Т.С., Денисова Е.А. Валидность шкал APACHE II, APACHE III, SAPS 2, SAPS 3 и SOFA у акушерских больных с сепсисом. Анестезиология иреаниматология. 2012; 6: 55–7. [Zabolotskikh I.B., Musaeva T.S., Denisova E.A. Validity of APACHE II, APACHE III, SAPS 2, SAPS 3 and SOFA scales in obstetric patients with sepsis. Anesteziologiya i reanimatologiya. 2012; 6: 55–7. (In Russ)]
  23. Астафьева М.Н., Руднов В.А., Кулабухов В.В. и др. Использование шкалы qSOFA в прогнозе исхода лечения у хирургических пациентов в ОРИТ. Субпопуляционный анализ материалов исследования РИСЭС. Хирургия. Журнал им. Н.И. Пирогова. 2019; 9: 58–65. DOI: 10.17116/hirurgia201909158 [Astafyeva M.N., Rudnov V.A., Kulabukhov V.V., et al. qSOFA score for prediction of outcome in surgical patients in intensive care units. Post hoc analysis of the Russian multi-center trial Rises (in Russian only). 2019; 9: 58–65. DOI: 10.17116/hirurgia201909158 (In Russ)]
  24. Meidert A.S., Buschmann D., Brandes F., et al. Molecular RNA Correlates of the SOFA Score in Patients with Sepsis. Diagnostics (Basel). 2021; 11(9): 1649. DOI: 10.3390/diagnostics11091649
  25. Jentzer J.C., van Diepen S., Hollenberg S.M., et al. Shock Severity Assessment in Cardiac Intensive Care Unit Patients With Sepsis and Mixed Septic-Cardiogenic Shock. Mayo Clin Proc Innov Qual Outcomes. 2021; 6(1): 37–44. DOI: 10.1016/j.mayocpiqo.2021.11.008
  26. Zhi D., Zhang M., Lin J., et al. Establishment and validation of the predictive model for the in-hospital death in patients with sepsis. Am J Infect Control. 2021; 49(12): 1515–21. DOI: 10.1016/j.ajic.2021.07.010
  27. Hernández G., Ospina-Tascón G.A., Damiani L.P., et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019; 321(7): 654–64. DOI: 10.1001/jama.2019.0071
  28. Magnin M., Amson H., Vacheron C.H., et al. Associations between peripheral perfusion disorders, mean arterial pressure and dose of norepinephrine administrated in the early phase of septic shock. Clin Exp Pharmacol Physiol. 2021; 48(10): 1327–35. DOI: 10.1111/1440-1681.13540
  29. Tartavoulle T., Fowler L. Cardiogenic Shock in the Septic Patient: Early Identification and Evidence-Based Management. Crit Care Nurs Clin North Am. 2018; 30(3): 379–87. DOI: 10.1016/j.cnc.2018.05.006
  30. Hollenberg S.M., Singer M. Pathophysiology of sepsis-induced cardiomyopathy. Nat Rev Cardiol. 2021; 18(6): 424–34. DOI: 10.1038/s41569-020-00492-2
  31. Ravikumar N., Sayed M.A., Poonsuph C.J., et al. Septic Cardiomyopathy: From Basics to Management Choices. Curr Probl Cardiol. 2021; 46(4): 100767. DOI: 10.1016/j.cpcardiol.2020.100767
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Copyright (c) 2022 ANNALS OF CRITICAL CARE

Most read articles by the same author(s)

<< < 1 2 3