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Disfunción miocárdica y su utilidad pronóstica en sepsis y choque séptico / Myocardial dysfunction and its prognostic utility in sepsis and septic shock
Resumen
Resumen
Introducción: la sepsis es una disfunción orgánica potencialmente mortal que está asociada a una infección; tiene alta morbilidad y mortalidad. La disfunción miocárdica asociada a sepsis es frecuente y se asocia con desenlaces desfavorables.
Objetivo: describir la distribución de la disfunción miocárdica por ecocardiografía transtorácica y estimar su utilidad pronóstica en sepsis y choque séptico.
Material y métodos: estudio de cohorte multicéntrico prospectivo, realizado en cuatro centros de referencia de Bucaramanga y su área metropolitana. Se incluyeron 271 pacientes con diagnóstico de sepsis y choque séptico, a quienes se les realizó ecocardiograma transtorácico y se les dio seguimiento por 30 días.
Resultados: no hubo diferencias en la fracción de eyección del ventrículo izquierdo entre sobrevivientes a los 30 días y no sobrevivientes. Se registraron 51 pacientes (48.7%) con disfunción diastólica grado I, 14.5% con disfunción grado II y 36.75% con disfunción grado III. Los pacientes con disfunción diastólica grado I tuvieron una mortalidad más alta que aquellos con disfunción diastólica de grado II (p = 0.023).
Conclusiones: la mayor mortalidad registrada en la disfunción diastólica grado I sugiere que los pacientes con bajas presiones de llenado tienen peores desenlaces. Por otra parte, la fracción de eyección del ventrículo izquierdo por sí sola no se relaciona con mayor mortalidad en sepsis.
Abstract
Background: Sepsis is a potentially mortal infection which is related to multiple organ dysfunction; it has a high morbidity and mortality. Myocardial dysfunction is frequent in sepsis and it is related to unfavorable outcomes.
Objective: To describe by transthoracic echocardiography the clinical distribution of myocardial dysfunction in sepsis and septic shock and estimate its prognostic utility.
Material and methods: Cross-sectional study based on a multi-centric prospective cohort study in 4 reference centers in Bucaramanga, Colombia, and its metropolitan area. 271 patients with sepsis and septic shock were included; they underwent standard transthoracic echocardiography and a 30-day follow-up.
Results: There was no difference in the left ventricular ejection fraction (p = 0.061) between survivors and nonsurvivors. 51 patients (48.71%) had grade I diastolic dysfunction, 48 patients (14.52%) had grade II dysfunction and 21 patients (36.75%) had grade III diastolic dysfunction. Mortality was higher in patients with grade I diastolic dysfunction when compared to those with grade II dysfunction (p = 0.023).
Conclusions: The higher mortality in grade I diastolic dysfunction suggests that patients with low filling pressures have worst outcomes. On the other hand, left ventricular ejection fraction per se is not associated with a higher mortality in sepsis.
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