Incidence, prognosis, and risk factors of sepsis-induced cardiomyopathy

doi:10.12998/wjcc.v9.i31.9452

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World Journal of Clinical Cases

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World J Clin Cases. Nov 6, 2021; 9(31): 9452-9468
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9452

Table 1 Baseline demographic data and clinical characteristics of patients included in the study

Covariate	Original patients (before matching)			PSM adjusted patients (after matching)			Missing data (%)
Covariate	Non-SIC (n = 2533)	SIC (n = 997)	P value	Non-SIC (n = 809)	SIC (n = 809)	P value	Missing data (%)
Age (yr)	64.46 ± 15.39	68.42 ± 15.21	0.000	68.06 ± 14.34	67.86 ± 15.37	0.791	0.0
Gender (Male), n (%)	1383 (54.6)	634 (63.6)	0.000	513 (63.4)	510 (63.0)	0.877	0.0
Height (cm)	169.22 ± 10.52	169.74 ± 12.16	0.236	169.34 ± 10.74	169.74 ± 11.28	0.466	12.1
Weight (kg)	84.19 ± 27.24	81.91 ± 25.49	0.027	80.74 ± 23.35	82.21 ± 26.16	0.233	6.2
BSA (m²)	1.88 ± 0.45	1.86 ± 0.45	0.224	1.91 ± 0.33	1.93 ± 0.36	0.218	12.6
BMI (kg/m²)	29.24 ± 8.77	28.85 ± 13.46	0.345	28.14 ± 7.69	28.59 ± 9.58	0.295	12.6
Temperature (℃)	36.88 ± 0.77	36.84 ± 0.79	0.267	37.02 ± 0.79	36.85 ± 0.76	0.000	2.1
SBP (mmHg)	111.42 ± 14.89	108.20 ± 14.05	0.000	110.55 ± 15.17	108.69 ± 14.21	0.011	1.6
DBP (mmHg)	57.60 ± 10.08	57.69 ± 10.09	0.821	59.18 ± 10.22	57.90 ± 9.99	0.011	1.6
MAP (mmHg)	73.20 ± 10.22	72.61 ± 10.15	0.130	75.09 ± 10.52	72.68 ± 9.96	0.000	1.5
HR (beats min^-1)	91.97 ± 17.38	92.32 ± 17.10	0.594	91.50 ± 17.23	92.41 ± 17.27	0.289	1.5
RR (min^-1)	21.20 ± 4.73	21.15 ± 4.45	0.789	21.32 ± 4.64	21.20 ± 4.46	0.572	1.5
SpO₂ (%)	96.84 ± 2.70	96.91 ± 2.92	0.458	96.75 ± 3.02	96.91 ± 2.75	0.269	1.6
SOFA score	6.89 ± 3.88	7.02 ± 3.71	0.342	6.86 ± 3.72	6.99 ± 3.72	0.496	0.0
SAPS-I score	20.90 ± 5.47	21.40 ± 5.36	0.013	22.03 ± 5.32	21.29 ± 5.27	0.005	0.0
SAPS-II score	44.09 ± 15.43	46.57 ± 14.86	0.000	46.15 ± 15.18	46.32 ± 15.00	0.825	0.0
ECI	13.76 ± 8.97	15.30 ± 8.73	0.000	14.56 ± 8.63	15.20 ± 8.83	0.142	0.0
Microbiology, n (%)
Positive	1387 (54.8)	560 (56.2)	0.448	463 (57.2)	453 (56.0)	0.616	0.0
Negative	1146 (45.2)	437 (43.8)	0.448	346 (42.8)	356 (44.0)	0.616	0.0
Interventions, n (%)
Renal replacement use (1^st d)	249 (9.8)	120 (12.0)	0.054	81 (10.0)	98 (12.1)	0.178	0.0
Mechanical ventilation use (1^st d)	1232 (48.6)	516 (51.8)	0.095	341 (42.2)	414 (51.2)	0.000	0.0
Comorbidities, n (%)
Renal failure	614 (24.2)	324 (32.5)	0.000	282 (34.9)	249 (30.8)	0.081	0.0
Liver failure	418 (16.5)	74 (7.4)	0.000	17 (2.1)	71 (8.8)	0.000	0.0
Diabetes	809 (31.9)	424 (42.5)	0.000	337 (41.7)	333 (41.2)	0.840	0.0
COPD	552 (21.8)	195 (19.6)	0.144	186 (23.0)	162 (20.0)	0.146	0.0
Coagulopathy	869 (34.3)	317 (31.8)	0.155	283 (35.0)	255 (31.5)	0.140	0.0
Admission type, n (%)
Emergency	2396 (94.6)	960 (96.3)	0.036	780 (96.4)	785 (97.0)	0.485	0.0
Elective	137 (5.4)	37 (3.7)	0.036	29 (3.6)	24 (3.0)	0.485	0.0
Sepsis type, n (%)
Sepsis	548 (21.6)	168 (16.9)	0.003	174 (21.5)	143 (17.7)	0.064	0.0
Severe sepsis	1315 (51.9)	567 (56.9)		411 (50.8)	454 (56.1)		0.0
Septic shock	670 (26.5)	262 (26.3)		224 (27.7)	212 (26.2)		0.0
Laboratory tests
WBC (10⁹/L)	16.50 ± 12.92	15.93 ± 9.65	0.206	17.15 ± 12.94	15.61 ± 9.17	0.006	0.3
Hemoglobin (g/dL)	9.37 ± 1.88	9.57 ± 1.81	0.004	9.42 ± 1.91	9.57 ± 1.79	0.099	0.3
Platelet (10⁹/L)	195.01 ± 137.10	199.63 ± 124.20	0.356	202.55 ± 139.20	200.23 ± 125.24	0.725	0.2
Sodium (mmol/L)	139.96 ± 5.62	140.04 ± 5.17	0.705	139.92 ± 5.59	140.02 ± 5.20	0.695	0.1
Potassium (mmol/L)	3.78 ± 0.62	3.82 ± 0.60	0.064	3.76 ± 0.63	3.81 ± 0.61	0.094	0.1
Chloride (mmol/L)	102.19 ± 7.57	102.09 ± 6.80	0.716	101.71 ± 7.25	102.25 ± 6.78	0.117	0.1
BUN (mg/dL)	39.02 ± 27.97	43.79 ± 27.74	0.000	40.22 ± 27.95	42.90 ± 27.39	0.052	0.2
Creatine (mg/dL)	2.21 ± 2.08	2.38 ± 2.02	0.023	2.43 ± 2.26	2.33 ± 2.04	0.389	0.1
Lactate (mmol/L)	3.30 ± 2.77	3.59 ± 3.16	0.012	3.20 ± 2.55	3.46 ± 3.01	0.074	14.5
Albumin (g/dL)	2.68 ± 0.67	2.78 ± 0.60	0.001	2.71 ± 0.66	2.76 ± 0.60	0.196	39.3
Bilirubin (mg/dL)	3.69 ± 7.35	1.82 ± 3.58	0.000	2.70 ± 5.50	1.78 ± 3.57	0.001	25.6
PH	7.34 ± 0.11	7.34 ± 0.11	0.358	7.34 ± 0.10	7.34 ± 0.11	0.592	27.3
PO₂(mmHg)	132.70 ± 86.45	140.77 ± 92.91	0.037	128.11 ± 81.34	136.85 ± 90.36	0.081	27.2
PCO₂(mmHg)	41.20 ± 14.08	39.92 ± 11.76	0.030	40.70 ± 14.25	39.81 ± 11.62	0.239	27.3
Bicarbonate (mmol/L)	20.74 ± 5.61	20.32 ± 5.34	0.042	20.35 ± 5.49	20.32 ± 5.18	0.916	0.1
Glucose (mg/dl)	140.88 ± 46.90	146.09 ± 51.54	0.004	145.48 ± 48.58	144.89 ± 48.96	0.808	1.6
CK-MB (%)	6.83 ± 6.87	5.82 ± 6.00	0.063	6.87 ± 7.11	5.40 ± 5.64	0.037	80.7
CK (U/L)	68.00 (31.00-194.00)	74.50 (32.00-229.00)	0.374	66.50 (30.00-212.25)	76.00 (32.00-269.00)	0.382	24.9
Troponin T (ng/mL)	0.33 ± 1.06	0.38 ± 1.24	0.319	0.41 ± 1.41	0.39 ± 1.25	0.814	34.0

Data shown are the mean ± SD, median (interquartile), or n (%). The definitions and diagnostic criteria for sepsis, severe sepsis, and septic shock were made according to the Surviving Sepsis Campaign Guidelines[24,25]. SIC: Sepsis-induced cardiomyopathy; PSM: Propensity score matching; BSA: Body surface area; BMI: Body mass index; SOFA: Sequential organ failure assessment, ranging from 0 to 24, with higher scores indicating a greater degree of organ failure; ECI: Elixhauser comorbidity index, and we used the modified van Walraven Elixhauser comorbidity score in our study, which consists of 30 comorbidity diseases, ranges from -19 to 89 points, with higher scores indicating a greater risk of hospital mortality; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; MAP: Mean arterial pressure; HR: Heart rate; RR: Respiratory rate; SAPS-I: Simplified acute physiologic score-I; SAPS-II: Simplified acute physiologic score-II; ICU: Intensive care unit; COPD: Chronic obstructive pulmonary disease; WBC: White blood cell; PCO₂: Partial pressure of carbon dioxide; PO₂: Partial pressure of oxygen; BUN: Blood urea nitrogen.

Table 2 Comparison of primary and secondary outcomes, n (%)

Outcome	Original patients (before matching)				PSM adjusted patients (after matching)
Outcome	Non-SIC (n = 2533)	SIC (n = 997)	OR (95%CI)	P value	Non-SIC (n = 809)	SIC (n = 809)	OR (95%CI)	P value
Hospital mortality	818 (32.3)	367 (36.8)	1.22 (1.05-1.42)	0.011	243 (30.0)	286 (35.4)	1.27 (1.03-1.57)	0.023
Mechanical ventilation use	1478 (58.3)	619 (62.1)	1.17 (1.01-1.36)	0.042	431 (53.3)	500 (61.8)	1.42 (1.16-1.73)	0.001
RRT use	290 (11.4)	116 (11.6)	1.02 (0.81-1.28)	0.876	91 (11.2)	94 (11.6)	1.04 (0.76-1.41)	0.815
Norepinephrine use	1276 (50.4)	589 (59.1)	1.42 (1.23-1.65)	0.000	433 (53.5)	474 (58.6)	1.23 (1.01-1.50)	0.040
Epinephrine use	63 (2.5)	62 (6.2)	2.59 (1.81-3.70)	0.000	25 (3.1)	46 (5.7)	1.88 (1.14-3.09)	0.012
Dopamine use	279 (11.0)	188 (18.9)	1.88 (1.54-2.30)	0.000	105 (13.0)	141 (17.4)	2.08 (1.08-1.86)	0.013
Vasopressin use	508 (20.1)	258 (25.9)	1.39 (1.17-1.65)	0.000	178 (22.0)	206 (25.5)	1.21 (0.96-1.52)	0.102
Length of ICU stay (d)
Overall	9.25 ± 11.66	9.11 ± 11.33	NA	0.749	9.35 ± 12.00	8.69 ± 9.74	NA	0.222
Survivors	8.82 ± 12.00	8.70 ± 11.77		0.827	8.71 ± 11.85	8.25 ± 9.55		0.479
Non-Survivors	10.15 ± 10.85	9.81 ± 10.51		0.616	10.82 ± 12.24	9.49 ± 10.03		0.167
Length of hospital stay (d)
Overall	24.83 ± 26.05	21.45 ± 20.84	NA	0.000	23.38 ± 23.01	21.22 ± 19.46	NA	0.042
Survivors	23.71 ± 23.69	21.92 ± 20.28		0.093	21.62 ± 19.17	21.40 ± 17.13		0.844
Non-Survivors	27.19 ± 30.29	20.61 ± 21.75		0.000	27.44 ± 29.69	20.84 ± 23.13		0.004

Vasopressor use including the use of norepinephrine, epinephrine, dopamine, or vasopressin. SIC: Sepsis-induced cardiomyopathy; PSM: Propensity score matching; RRT: Renal replacement therapy; ICU: Intensive care unit; NA: Not available.

Table 3 Baseline demographic data and clinical characteristics of patients with sepsis-induced cardiomyopathy

Covariate	Survivors (n = 630)	Non-survivors (n = 367)	P value	Missing data (%)
Age (yr)	67.26 ± 15.80	70.42 ± 13.97	0.002	0
Gender (Male), n (%)	402 (63.8)	232 (63.2)	0.851	0
Height (cm)	169.92 ± 12.52	169.44 ± 11.51	0.575	12.4
Weight (kg)	83.44 ± 26.22	79.15 ± 23.91	0.014	6.7
BSA (m²)	1.88 ± 0.46	1.83 ± 0.43	0.128	12.8
BMI (kg/m²)	29.38 ± 15.02	27.92 ± 10.06	0.124	12.8
Temperature (℃)	36.90 ± 0.73	36.74 ± 0.88	0.002	2.9
SBP (mmHg)	109.72 ± 13.65	105.59 ± 14.34	0	1.9
DBP (mmHg)	58.36 ± 9.67	56.53 ± 10.70	0.006	1.9
MAP (mmHg)	73.32 ± 9.62	71.41 ± 10.91	0.005	1.8
HR (beats/min)	91.36 ± 16.88	93.95 ± 17.38	0.022	1.8
RR (/min)	20.98 ± 4.33	21.44 ± 4.65	0.119	1.8
SpO₂(%)	97.19 ± 2.40	96.43 ± 3.60	0	2
SOFA score	6.28 ± 3.38	8.29 ± 3.91	0	0
SAPS-I score	20.37 ± 4.89	23.19 ± 5.66	0	0
SAPS-II score	42.90 ± 13.54	52.87 ± 14.94	0	0
ECI	14.36 ± 8.47	16.92 ± 8.93	0	0
Microbiology, n (%)
Positive	354 (56.2)	206 (56.1)	0.985	0
Negative	276 (43.8)	161 (43.9)
Interventions, n (%)
Renal replacement use (1^st 24 h)	69 (11.0)	51 (13.9)	0.168	0
Mechanical ventilation use (1^st 24 h)	296 (47.0)	220 (59.9)	0	0
Comorbidities, n (%)
Renal failure	189 (30.0)	135 (36.8)	0.027	0
Liver failure	46 (7.3)	28 (7.6)	0.849	0
Diabetes	272 (43.2)	152 (41.4)	0.588	0
COPD	117 (18.6)	78 (21.3)	0.303	0
Coagulopathy	172 (27.3)	145 (39.5)	0	0
Admission type, n (%)
Emergency	608 (96.5)	352 (95.9)	0.632	0
Elective	22 (3.5)	15 (4.1)		0
Sepsis type, n (%)
Sepsis	143 (22.7)	25 (6.8)	0	0
Severe sepsis	336 (53.3)	231 (62.9)		0
Septic shock	151 (24.0)	111 (30.2)		0
Laboratory tests
WBC (10⁹/L)	15.88 ± 9.23	16.03 ± 10.36	0.809	0.1
Hemoglobin (g/dL)	9.56 ± 1.84	9.59 ± 1.76	0.812	0.2
Platelet (10⁹/L)	214.36 ± 127.73	174.26 ± 113.66	0	0.1
Sodium (mmol/L)	140.05 ± 4.93	140.03 ± 5.58	0.965	0
Potassium (mmol/L)	3.78 ± 0.61	3.88 ± 0.59	0.018	0
Chloride (mmol/L)	102.26 ± 6.58	101.78 ± 7.18	0.287	0.1
BUN (mg/dL)	39.46 ± 24.07	51.24 ± 31.80	0	0.2
Creatine (mg/dL)	2.23 ± 1.94	2.63 ± 2.13	0.003	0.2
Lactate (mmol/L)	2.98 ± 2.12	4.62 ± 4.19	0	14.1
Albumin (g/dL)	2.83 ± 0.58	2.69 ± 0.61	0.004	39.8
Bilirubin (mg/dL)	1.49 ± 3.16	2.34 ± 4.10	0.002	26.8
PH	7.35 ± 0.11	7.32 ± 0.12	0.001	26.3
PO₂(mmHg)	142.73 ± 93.83	137.98 ± 91.67	0.495	26.3
PCO₂(mmHg)	40.36 ± 10.79	39.30 ± 13.01	0.23	26.3
Bicarbonate	21.01 ± 5.00	19.13 ± 5.69	0	0.1
(mmol/L)	21.01 ± 5.00	19.13 ± 5.69	0	0.1
Glucose (mg/dL)	144.45 ± 47.67	148.89 ± 57.53	0.193	1.8
CK-MB (%)	5.73 ± 5.64	6.00 ± 6.73	0.767	78.5
CK (U/L)	413.37 ± 1425.54	313.84 ± 842.98	0.284	22.4
Troponin (ng/mL)	0.42 ± 1.41	0.31 ± 0.87	0.264	33.4
Outcomes, n (%)
Mechanical ventilation use	343 (54.4)	276 (75.2)	0	0
RRT use	44 (7.0)	72 (19.6)	0	0
Norepinephrine use	322 (51.1)	267 (72.8)	0	0
Epinephrine use	27 (4.3)	35 (9.6)	0.001	0
Dopamine use	94 (14.9)	94 (25.6)	0	0
Vasopressin use	95 (15.1)	163 (44.4)	0	0
Length of ICU stay (d)	8.71 ± 11.77	9.81 ± 10.51	0.138	0
Length of hospital stay (d)	21.94 ± 20.29	20.61 ± 21.75	0.332	0

Data shown are the mean ± SD or n (%). The definitions and diagnostic criteria for sepsis, severe sepsis, and septic shock were made according to the Surviving Sepsis Campaign Guidelines[24,25]. BSA: Body surface area; BMI: Body mass index; SOFA: Sequential organ failure assessment, ranging from 0 to 24, with higher scores indicating a greater degree of organ failure ; ECI: Elixhauser comorbidity index, and we used the modified van Walraven Elixhauser comorbidity score in our study, which consists of 30 comorbidity diseases and ranges from -19 to 89 points, with higher scores indicating a greater risk of hospital mortality; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; MAP: Mean arterial pressure; HR: Heart rate; RR: Respiratory rate; SAPS-I: Simplified acute physiologic score-I; SAPS-II: Simplified acute physiologic score-II; ICU: Intensive care unit; COPD: Chronic obstructive pulmonary disease; WBC: White blood cell; PCO₂: Partial pressure of carbon dioxide; PO₂: Partial pressure of oxygen; BUN: Blood urea nitrogen.

Table 4 Multivariate logistic analysis of risk factors for sepsis-induced cardiomyopathy

Covariate	OR	95%CI	P value
Age	1.012	1.006-1.017	0.000
Male	1.498	1.264-1.776	0.000
ECI	1.036	1.025-1.046	0.000
Hemoglobin	1.067	1.020-1.116	0.005
MV use¹	1.003	1.000-1.006	0.041
Diabetes	1.538	1.298-1.823	0.000
Liver failure	0.340	0.251-0.459	0.000
SBP	0.983	0.977-0.989	0.000

¹MV use means mechanical ventilation use in the first day of intensive care unit admission. ECI: Elixhauser comorbidity index, and we used the modified van Walraven Elixhauser comorbidity score in our study, which consists of 30 comorbidity disease and ranges from -19 to 89 points, with higher scores indicating a greater risk of hospital mortality; OR: Odds ratio; SBP: Systolic blood pressure.

Table 5 Multivariate logistic regression analysis for risk factors of hospital death in sepsis-induced cardiomyopathy patients

Covariate	OR	95%CI	P value
Lactate	1.107	1.038-1.180	0.002
SAPS-II score	1.035	1.021-1.049	0.000
Sepsis types	1.386	1.066-1.801	0.015
BUN	1.009	1.003-1.015	0.006
SBP	0.986	0.973-1.000	0.044
Platelet level	0.998	0.997-1.000	0.031

SAPS-II: Simplified acute physiologic score-II; Sepsis types included sepsis, severe sepsis, and septic shock; the hospital mortality level in the sepsis group was set as baseline level and was set as 0, severe sepsis was set as 1, and septic shock was set as 2 in this multivariate logistic analysis. OR: Odds ratio; BUN: blood urea nitrogen; SBP: Systolic blood pressure.

Citation: Liang YW, Zhu YF, Zhang R, Zhang M, Ye XL, Wei JR. Incidence, prognosis, and risk factors of sepsis-induced cardiomyopathy. World J Clin Cases 2021; 9(31): 9452-9468
URL: https://www.wjgnet.com/2307-8960/full/v9/i31/9452.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i31.9452