Analysis on correlation factors of left ventricular diastolic dysfunction and its association with mortality in the patients with septic shock

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Objective To study the determinants of left ventricular diastolic dysfunction (LVDD) and investigate its association with mortality in patients with septic shock. Methods Totally 127 patients with septic shock in Zhejiang Provincial People’s Hospital recruited from June 2014 to December 2015 were divided into the LVDD group (49 cases) and control group as patients with normal left ventricular diastolic function (78 cases). General data of the two groups were compared. According to diastolic function underwent trans-thoracic echocardiography examination within 24 h after admission to ICU, LVDD was assessed as the conbination early diastolic mitral annulus velocity (E’) with the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/E’). The related factors of LVDD in patients with septic shock were analyzed by Pearson simple correlation, and the risk factors associated with mortality in patients with septic shock were evaluated by multivariate Logistic regression. Results Compared with the normal group, the age [(63 ± 14) years vs. (58 ± 18) years], systolic blood pressure admitted to ICU [(90 ± 18) mmHg vs. (99 ± 18) mmHg], coronary atherosclerotic heart disease (CHD) (15/49 vs. 12/78), serum creatinine [(188 ± 96) μmol/L vs. (116 ± 92) μmol/L], acute physiology and chronic health evaluation (APACHE) Ⅱ scores [(21 ± 5) vs. (17 ± 6)], plasma brain natriuretic peptide (BNP) [(178 ± 84) pg/mL vs. (355 ± 128) pg/mL], left ventricular end systolic diamete (LVESD) [(34 ± 8) mm vs. (31 ± 5) mm], interventricular septal thickness (IVST) [(10.1 ± 1.9) mm vs. (9.4 ± 1.4) mm], left ventricular posterior wall thickness (PWT) [(10.2 ± 1.5) mm vs. (9.6 ± 1.2) mm], mitral annular systolic velocity peak (S’) [(9.0 ± 3.0) cm/s vs. (11.4 ± 3.6) cm/s], E’[(7.3 ± 2.3) cm/s vs. (12.3 ± 3.6) cm/s] and E/E’[(11.6 ± 4.0) vs. (6.8 ± 2.6)] of these two groups were significantly different (all P < 0.05). Correlation analysis showed that E/E’ had a positive correlation with age, hypertension, CHD, plasma BNP and APACHEⅡ score (r = 0.302, 0.289, 0.277, 0.418, 0.290; all P < 0.05). However, the systolic blood pressure admitted to ICU and left ventricular eject fraction (LVEF) had negative correlations with those parameters (r = -0.239, -0.284; all P < 0.05). Multivariate Logistic regression analysis found that age [OR = 1.040, 95% CI (1.020, 1.071)], blood lactic acid [OR = 1.492, 95% CI (1.176, 1.732)], plasma BNP [OR = 2.051, 95% CI (1.232, 2.964)], E/E’ [OR = 1.362, 95% CI (1.122, 1.534)] and APACHE Ⅱ score [OR = 2.370, 95% CI (1.131, 3.674)] were the independent risk factors associated with mortality in patients with septic shock (all P < 0.05). Conclusions Age, systolic blood pressure admitted to ICU, hypertension, CHD, plasma BNP, APACHEⅡ score and LVEF were significantly related to LVDD. However, age, blood lactic acid, plasma BNP, E/E’and APACHE Ⅱ score were the independent risk factors associated with mortality in patients with septic shock. Key words: Septic shock; Left ventricular diastolic dysfunction; B-type brain natriuretic peptide; Prognosis