1237: NOVEL ANALYSIS OF ECHOCARDIOGRAM INDICES AND THEIR ASSOCIATION WITH OUTCOMES IN PEDIATRIC SEPSIS

Abstract

Introduction: Sepsis induced myocardial dysfunction is common in pediatric sepsis. We sought to utilize novel, specialized algorithms of echocardiogram data that allow for automatic acquisition of echocardiographic indices from all four chambers without advanced interpretation by cardiologists. We hypothesized that these algorithms could predict mortality and morbidity in septic children. Methods: A retrospective cohort study of 59 children admitted to the ICU with sepsis and echocardiogram data. Three user inputted points outlining each heart chamber were applied to existing echocardiograms. Novel algorithms then computed the relevant echocardiographic indices. We examined right and left sided indices for systolic function [ejection fraction (EF), stroke volume (SV) systolic wave (S’)], diastolic function [early diastolic annular velocity (E’), late diastolic annular velocity (A’)], chamber sizes, and strain indices. Our primary outcome was mortality, secondary outcomes included ventilator free days (VFD) at 28 days, and length of stay (LOS). Linear regression models were constructed. Results: Six (10.2%) of 59 patients died. Baseline characteristics were similar between survivors and nonsurvivors. Survivors had higher right ventricular (RV) SV [11.2 mL (4.7, 52.3) versus 3.04 mL (2.1, 4.2), p=0.010], RV (S’) [6.2 cm/s (5.0, 7.6) versus 4.5 cm/s (2.9, 6.2), p=0.046] and RV end-diastolic volume (EDV) [29.6 mL (12.3, 70.9) versus 9.1 mL (5.8, 17.6), p=0.016]. Multiple right chamber indices were associated with more VFD at 28 days [RV S’: β 2.7 (1.3 to 4.1), p=< 0.000, RV E’: β 2.3 (0.9 to 3.6), p=0.002, right atrial (RA) SV: β 0.3 (0.1 to 0.5), p=0.010, RA EF: β 0.2 (0.0 to 0.4) p=0.047, and RA EDV: β 0.4 (0.1 to 0.8) p=0.017]. Multiple diastolic indices were associated with differences in both ICU LOS in hours [left ventricular (LV) A’: β -129.5 (-208.4 to -50.6), p=0.020; RV S’: β -96.1 (-168.7 to -23.4), p=0.01] and hospital LOS in hours [LV A’: β -144.9 (-266.6 to -23.4), p=0.02; RV S’: β -145.1 (-260.7 to -29.6), p=0.015]. Conclusions: In this cohort of children with sepsis, echocardiographic indices as measured by our point of care, novel algorithms can be utilized to risk stratify these high-risk patients. Right sided chambers appear to be more predictive of both mortality and morbidity.