Abstract PD-047: PREDICTORS OF SEPSIS INDUCED MYOCARDIAL DYSFUNCTION AT ADMISSION IN CHILDREN WITH SEPTIC SHOCK

Abstract

Aims & Objectives: To determine predictors of sepsis induced myocardial dysfunction (SIMD) at admission in children with septic shock. Methods We retrospectively reviewed the records of children aged 3 months to 17 years of age, admitted with a diagnosis of fluid refractory septic shock in pediatric Intensive Care Unit (ICU) of a tertiary care hospital between 2015 and 2017. Data collection included demographic, clinical, laboratory and outcome related variables in all who had undergone 2D echocardiography within 3 hours of admission. SIMD was defined as presence of systolic and/or diastolic dysfunction. Data were analyzed using Stata 11 software. Results Out of 122 children admitted with fluid refractory septic shock, 95 underwent echocardiography within 3 hours of admission. Prevalence of SIMD was 46% (95% CI: 34 to 51). On univariate analysis, in comparison to those ‘without SIMD’, children ‘with SIMD’ had longer capillary refill time (CRT) (seconds) (2.8 vs. 2.4), increased lactate (mmol/L) (2.8 vs.1.2), lower platelet count (105/mm3) (1.51 vs. 3), increased blood urea (mg/dL) (44.5 vs. 24) and increased alanine transaminase (ALT) (U/L) (49 vs. 27) (p<0.05 for all). On multivariate analysis, none of these factors were found to be significant. The mortality rate was 57% (16) vs. 21% (9) (p=0.04) in those ‘with SIMD’ and ‘without SIMD’, respectively. Conclusions Clinical and laboratory parameters like prolonged CRT, increased lactate, lower platelet count, increased blood urea and elevated liver enzymes at admission may predict presence of SIMD at admission in children with septic shock. However, larger prospective studies are required to confirm these associations.