Etiology of sepsis and cardiac dysfunction among critically ill patients with sepsis and septic shock

SESSION TITLE: Critical Care Posters 4 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Cardiac dysfunction is a significant comorbidity in septic patients and is associated with worse outcomes. Previously, streptococcal septicemia in patients and Eschichia coli bacteremia in rodent models has been linked to an increased risk of cardiovascular events. However, it remains unclear if similar associations exist between heart function and other organisms. Furthermore, it is unknown if specific sites of infection contribute directly to cardiac dysfunction. The aim of this retrospective cohort study was to evaluate the association between the etiology of sepsis and cardiac dysfunction in critically ill patients. METHODS: This study included adult patients (≥18 years) admitted to the Medical Intensive Care Unit (MICU) with sepsis and septic shock between 01/2011 and 12/2020. All patients who had a transthoracic echocardiogram (TTE) done within 72 hours of admission were included. Patients were divided into three groups based on their left ventricular ejection fraction (LVEF): reduced systolic function (LVEF ≤ 40%), normal (LVEF 40 – 70%), and hyperdynamic (LVEF ≥ 70%). Baseline characteristics, echocardiographic parameters, microbiological data, and outcomes were compared among the three groups. RESULTS: A total 3,151 patients with sepsis and septic shock had a TTE during their MICU admission and met the inclusion criteria (LVEF ≤ 40%, 438 patients; LVEF 40 – 70%, 2360 patients; LVEF ≥ 70%, 353 patients). Patients in the LVEF ≤ 40%, were older (67 [IQR: 56 – 77] vs 63 [53 – 73] vs 64 [53 – 70], p < 0.001). The median APACHE III score of each LVEF category from reduced to hyperdynamic was as follows: 94 [74 – 120], 85 [66 – 107] and 93 [74 – 116] (p < 0.001) respectively. 28-day ICU mortality of each LVEF category from reduced LVEF to hyperdynamic LVEF was as follows: 37%, 24.5% and 38.7% respectively. Overall, the most frequent site of infection was the respiratory tract (22.5%). Among the patients with LVEF ≤ 40%, respiratory (24%), unknown (22.8%) and genitourinary (15.5%) sources of sepsis accounted for the most common etiologies of sepsis. However, patients with LVEF ≥70%, respiratory (21.1%)and intra-abdominal (15.5%) were most common site of infection. Similarly in the normal LV function group, respiratory (22.4%) and genitourinary (16.9 %) were common site of infection. There was a significantly higher frequency of gram-negative pathogens in the LVEF ≤ 40 (26.3% vs 22.6% and 15.5%, p = 0.003) compared to the LVEF 40 – 70% and LVEF ≥ 70% group. The presence of gram-positive pathogens, fungi, viruses, and resistive organisms was similar across the three groups. In our cohort, bacteremia was present in 1,115 patients (35.4%). Though, there was no difference in the rates of bacteremia in each group (LVEF ≤ 40, 38.8%; LVEF 40 – 70%, 35.3%; LVEF ≥ 70%, 30.6%, p = 0.08). CONCLUSIONS: In this study, our results show that infection with gram-negative organisms was frequently observed in reduced LVEF group with sepsis. CLINICAL IMPLICATIONS: Obtaining an understanding of pathologic effects associated with different organism types may be useful for determining therapeutic options for prevention of cardiac dysfunction in sepsis. DISCLOSURES: No relevant relationships by Mahmoud Alwakeel No relevant relationships by Sanchit Chawla No relevant relationships by Angel Coz Yataco No relevant relationships by Siddharth Dugar Advisory Committee Member relationship with Alung Please note: 8/2021 by Abhijit Duggal, value=Consulting fee No relevant relationships by Tyler Jones No relevant relationships by Talha Saleem