Is Left Ventricular Systolic Dysfunction Associated With Increased Mortality Among Patients With Sepsis and Septic Shock?

Background The impact of left ventricular systolic function on outcomes in patients with sepsis and septic shock remains uncertain. The association, if any, may be nonlinear. Research Question Is left ventricular systolic dysfunction associated with increased mortality among patients with sepsis and septic shock? Study Design and Methods Retrospective cohort study comprising all adult patients admitted to the medical intensive care unit (MICU) from January 1, 2011, to December 31, 2020, with sepsis and septic shock as defined by sepsis 3 guidelines. All adult patients with sepsis or septic shock who underwent transthoracic echocardiogram (TTE) within 3 days from admission to MICU were included. We divided patients into five groups based on LVEF. In addition to univariate analysis, we also performed multivariable logistic regression analysis adjusting for patients’ baseline characteristics and the severity of illness. The primary outcome was the association between each classification of LVEF and in-hospital mortality. Results A total of 3,151 patients were included in this study (LVEF <25%, 133 patients; 25%≤ LVEF <40%, 305 patients; 40%≤ LVEF <55%, 568 patients; 55%≤ LVEF <70%, 1,792 patients; and LVEF ≥70%, 353 patients). In-hospital mortalities in each LVEF category were 51.1%, 34.8%, 26.6%, 26.2%, and 41.9%, respectively. In the multivariable logistic regression analysis, LVEF <25% (OR, 2.75, 95% CI, 1.82-4.17, p< 0.001) and LVEF ≥70% (OR, 1.70; 95%CI, 1.09-1.88; p=0.010) were independently associated with significantly higher in-hospital mortality, compared to the reference LVEF category (55-70%). Interpretation The association of LVEF to in-hospital mortality in sepsis and septic shock was U-shaped. Both severe LV systolic dysfunction (LVEF <25%) and hyper-dynamic LVEF (LVEF ≥70%) were independently associated with significantly higher in-hospital mortality.