Predictors of sepsis induced myocardial dysfunction at admission in children with septic shock

Abstract

Background : Sepsis induced myocardial dysfunction (SIMD) is commonly seen in patients with septic shock and is often associated with poor clinical outcomes. Determining predictors of myocardial dysfunction at admission by clinical examination and simple bedside laboratory tests would help identify such patients prior to 2 D echocardiography or even in its absence. Such information would help exercise caution with fluid administration and warrant early initiation of inotropes. It would also help in predicting the clinical course and prognosis. Methods : In this retrospective review, we reviewed records of children =17 years of age, admitted with a diagnosis of septic shock in our pediatric Intensive Care Unit (ICU) between 2015 and 2017. Detailed information on demographic, clinical, laboratory variables, treatment received and clinical course were recorded in all who had undergone 2 D echocardiography at admission. SIMD was defined as presence of systolic and/or diastolic dysfunction. Systolic dysfunction was defined as an abnormal ejection fraction (EF) and diastolic dysfunction as an abnormal doppler tissue velocity (E’) and/or an abnormal Myocardial Performance Index (MPI). Data were analyzed using Stata 11 software. Results : A total of 149 children were eligible. Of these 27 had not undergone echocardiography and were excluded; 122 children (54% boys) were included in the analysis. Median (IQR) age was 5 (1, 10) years. Most common cause of sepsis was pneumonia (45; 37%). The prevalence of SIMD was 43% (95% CI: 34 to 51) in the study population. Systolic plus diastolic dysfunction was present in 30% (95% CI: 22 to 38) patients and only diastolic dysfunction was present in 13% (95% CI: 8 to 20) patients. The mean (SD) ejection fraction (EF) was 0.47 (0.13) and 0.62 (0.06) ( p Conclusion : SIMD is commonly seen in children with septic shock and the mortality and mortality are higher in those with SIMD as compared to those without. 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 in children with septic shock.