Analysis on correlation factors of left ventricular diastolic dysfunction and its association with mortality in the patients with septic shock

doi:10.3877/cma.j.issn.1674-6880.2017.02.005

Abstract

Abstract:

Objective

To study the determinants of left ventricular diastolic dysfunction (LVDD) and investigate its association with mortality in patients with septic shock.

Methods

Totally 127 patients with septic shock in Zhejiang Provincial People’s Hospital recruited from June 2014 to December 2015 were divided into the LVDD group (49 cases) and control group as patients with normal left ventricular diastolic function (78 cases). General data of the two groups were compared. According to diastolic function underwent trans-thoracic echocardiography examination within 24 h after admission to ICU, LVDD was assessed as the conbination early diastolic mitral annulus velocity (E’) with the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/E’). The related factors of LVDD in patients with septic shock were analyzed by Pearson simple correlation, and the risk factors associated with mortality in patients with septic shock were evaluated by multivariate Logistic regression.

Results

Compared with the normal group, the age [(63 ± 14) years vs. (58 ± 18) years], systolic blood pressure admitted to ICU [(90 ± 18) mmHg vs. (99 ± 18) mmHg], coronary atherosclerotic heart disease (CHD) (15/49 vs. 12/78), serum creatinine [(188 ± 96) μmol/L vs. (116 ± 92) μmol/L], acute physiology and chronic health evaluation (APACHE) Ⅱ scores [(21 ± 5) vs. (17 ± 6)], plasma brain natriuretic peptide (BNP) [(178 ± 84) pg/mL vs. (355 ± 128) pg/mL], left ventricular end systolic diamete (LVESD) [(34 ± 8) mm vs. (31 ± 5) mm], interventricular septal thickness (IVST) [(10.1 ± 1.9) mm vs. (9.4 ± 1.4) mm], left ventricular posterior wall thickness (PWT) [(10.2 ± 1.5) mm vs. (9.6 ± 1.2) mm], mitral annular systolic velocity peak (S’) [(9.0 ± 3.0) cm/s vs. (11.4 ± 3.6) cm/s], E’[(7.3 ± 2.3) cm/s vs. (12.3 ± 3.6) cm/s] and E/E’[(11.6 ± 4.0) vs. (6.8 ± 2.6)] of these two groups were significantly different (all P < 0.05). Correlation analysis showed that E/E’ had a positive correlation with age, hypertension, CHD, plasma BNP and APACHEⅡ score (r = 0.302, 0.289, 0.277, 0.418, 0.290; all P < 0.05). However, the systolic blood pressure admitted to ICU and left ventricular eject fraction (LVEF) had negative correlations with those parameters (r = -0.239, -0.284; all P < 0.05). Multivariate Logistic regression analysis found that age [OR = 1.040, 95% CI (1.020, 1.071)], blood lactic acid [OR = 1.492, 95% CI (1.176, 1.732)], plasma BNP [OR = 2.051, 95% CI (1.232, 2.964)], E/E’ [OR = 1.362, 95% CI (1.122, 1.534)] and APACHE Ⅱ score [OR = 2.370, 95% CI (1.131, 3.674)] were the independent risk factors associated with mortality in patients with septic shock (all P < 0.05).

Conclusions

Age, systolic blood pressure admitted to ICU, hypertension, CHD, plasma BNP, APACHEⅡ score and LVEF were significantly related to LVDD. However, age, blood lactic acid, plasma BNP, E/E’and APACHE Ⅱ score were the independent risk factors associated with mortality in patients with septic shock.

Key words: Septic shock, Left ventricular diastolic dysfunction, B-type brain natriuretic peptide, Prognosis

Bangchuan Hu, Yujia Wang, Weidong Ge, Fengzhi Li, Renhua Sun. Analysis on correlation factors of left ventricular diastolic dysfunction and its association with mortality in the patients with septic shock[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(02): 92-97.

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References 24

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组别	例数	入ICU收缩压（mmHg）	入ICU舒张压（mmHg）	血糖（mmol/L）	白蛋白（g/L）	血乳酸（mmol/L）
LVDD组	49	90 ± 18	57 ± 16	9.2 ± 1.6	32 ± 4	2.9 ± 1.3
对照组	78	99 ± 18	60 ± 14	9.0 ± 1.4	32 ± 6	2.8 ± 1.8
t/χ²值	?	2.633	1.269	0.441	0.132	0.247
P值	?	0.024	0.197	0.632	0.922	0.787
组别	例数	血肌酐（μmol/L）	APACHEⅡ评分（分）	肌钙蛋白I（ng/mL）	血浆BNP（pg/mL）	血管活性药物使用（例，%）
LVDD组	49	188 ± 96	21 ± 5	0.7 ± 1.6	355 ± 128	45（91.8%）
对照组	78	116 ± 92	17 ± 6	0.5 ± 1.6	178 ± 84	69（88.5%）
t/χ²值	?	3.819	4.558	0.653	5.848	0.371
P值	?	< 0.001	< 0.001	0.523	< 0.001	0.542

组别	例数	入ICU收缩压（mmHg）	入ICU舒张压（mmHg）	血糖（mmol/L）	白蛋白（g/L）	血乳酸（mmol/L）
LVDD组	49	90 ± 18	57 ± 16	9.2 ± 1.6	32 ± 4	2.9 ± 1.3
对照组	78	99 ± 18	60 ± 14	9.0 ± 1.4	32 ± 6	2.8 ± 1.8
t/χ²值	?	2.633	1.269	0.441	0.132	0.247
P值	?	0.024	0.197	0.632	0.922	0.787
组别	例数	血肌酐（μmol/L）	APACHEⅡ评分（分）	肌钙蛋白I（ng/mL）	血浆BNP（pg/mL）	血管活性药物使用（例，%）
LVDD组	49	188 ± 96	21 ± 5	0.7 ± 1.6	355 ± 128	45（91.8%）
对照组	78	116 ± 92	17 ± 6	0.5 ± 1.6	178 ± 84	69（88.5%）
t/χ²值	?	3.819	4.558	0.653	5.848	0.371
P值	?	< 0.001	< 0.001	0.523	< 0.001	0.542

组别	例数	LVEDD（mm）	LVESD（mm）	IVST（mm）	PWT（mm）	LVEF（分）	E（m/s）
LVDD组	49	50 ± 7	34 ± 8	10.1 ± 1.9	10.2 ± 1.5	53 ± 14	0.85 ± 0.30
对照组	78	49 ± 6	31 ± 5	9.4 ± 1.4	9.6 ± 1.2	55 ± 10	0.84 ± 0.22
t/χ²值	?	1.123	2.459	2.782	2.374	0.830	0.292
P值	?	0.276	0.032	0.025	0.037	0.326	0.734
组别	例数	A（m/s）	E/A	DT（m/s）	S’（cm/s）	E’（cm/s）	E/E’
LVDD组	49	0.84 ± 0.32	1.1 ± 0.6	134 ± 57	9.0 ± 3.0	7.3 ± 2.3	11.6 ± 4.0
对照组	78	0.77 ± 0.21	1.1 ± 0.4	146 ± 54	11.4 ± 3.6	12.3 ± 3.6	6.8 ± 2.6
t/χ²值	?	1.353	0.618	0.865	3.948	6.786	5.320
P值	?	0.201	0.553	0.302	< 0.001	< 0.001	< 0.001

组别	例数	LVEDD（mm）	LVESD（mm）	IVST（mm）	PWT（mm）	LVEF（分）	E（m/s）
LVDD组	49	50 ± 7	34 ± 8	10.1 ± 1.9	10.2 ± 1.5	53 ± 14	0.85 ± 0.30
对照组	78	49 ± 6	31 ± 5	9.4 ± 1.4	9.6 ± 1.2	55 ± 10	0.84 ± 0.22
t/χ²值	?	1.123	2.459	2.782	2.374	0.830	0.292
P值	?	0.276	0.032	0.025	0.037	0.326	0.734
组别	例数	A（m/s）	E/A	DT（m/s）	S’（cm/s）	E’（cm/s）	E/E’
LVDD组	49	0.84 ± 0.32	1.1 ± 0.6	134 ± 57	9.0 ± 3.0	7.3 ± 2.3	11.6 ± 4.0
对照组	78	0.77 ± 0.21	1.1 ± 0.4	146 ± 54	11.4 ± 3.6	12.3 ± 3.6	6.8 ± 2.6
t/χ²值	?	1.353	0.618	0.865	3.948	6.786	5.320
P值	?	0.201	0.553	0.302	< 0.001	< 0.001	< 0.001

指标	回归系数	标准误	OR值	95%CI	Wald值	P值
年龄（岁）	0.041	0.030	1.040	1.020 ~ 1.071	5.631	0.022
血乳酸（mmol/L）	0.202	0.123	1.492	1.176 ~ 1.732	4.894	0.032
血浆BNP（ng/L）	0.289	0.103	2.051	1.232 ~ 2.964	8.569	0.007
E/E’	0.151	0.053	1.362	1.122 ~ 1.534	3.980	0.043
APACHEⅡ评分（分）	0.318	0.116	2.370	1.131 ~ 3.674	10.52	0.001

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