Prognostic value of left ventricular-arterial coupling in elderly patients with septic shock

Abstract

PurposeTo investigate the predictive value of left ventricular-arterial coupling (VAC) for clinical prognosis of elderly patients with septic shock. Materials and methodsThis was a single-center prospective cohort study of 63 elderly patients with septic shock treated between August 2014 and January 2016 at the 30-bed intensive care unit (ICU) of Zhejiang Hospital (China). Left VAC was evaluated by transthoracic echocardiography (TTE). End-systolic elastance (Ees) and left ventricular ejection fraction (LVEF) were measured; arterial elastance (Ea) was calculated. The 28-day survival was evaluated. ResultsCompared with non-survivors, survivors had a significantly lower Ea/Ees ratio (P<0.01), mainly because survivors had higher Ees values (P<0.01), but without difference in Ea (P=0.720). LVEF was greater (47.5±7.3 vs. 43.6±6.4, P=0.03); LVESV was smaller in survivors compared to non-survivors (P<0.05). The multivariate Cox proportional regression analysis showed that APACHEII scores (hazard ratio (HR)=1.12, 95% confidence interval (95%CI):1.01–1.25, P=0.04), blood lactate levels (HR=1.21, 95%CI:1.07–1.36, P=0.002), and VAC (HR=2.57, 95%CI:1.29–5.13, P=0.007) were independently associated with 28-day mortality of elderly patients with septic shock. The optimal cutoff point of VAC for predicting 28-day mortality was 2.14 with 56.7% sensibility and 87.9% specificity; the area under the curve was 0.74. ConclusionsLeft VAC has prognostic value in elderly patients with septic shock.