Valor prognóstico da disfunção ventricular diastólica em pacientes com sepse grave e choque séptico

Gustavo Rolando, Emilio Daniel Valenzuela Espinoza, Emelin Avid, Sebastián Welsh, Juan Del Pozo, Alejandro Risso Vazquez, Yanina Arzani, Fabio Daniel Masevicius, Arnaldo Dubin

To evaluate the prevalence of myocardial dysfunction and its prognostic value in patients with severe sepsis and septic shock. Adult septic patients admitted to an intensive care unit were prospectively studied using transthoracic echocardiography within the first 48 hours after admission and thereafter on the 7th-10th days. Echocardiographic variables of biventricular function, including the E/e' ratio, were compared between survivors and non-survivors. A total of 99 echocardiograms (53 at admission and 46 between days 7 - 10) were performed on 53 patients with a mean age of 74 (SD 13) years. Systolic and diastolic dysfunction was present in 14 (26%) and 42 (83%) patients, respectively, and both types of dysfunction were present in 12 (23%) patients. The E/e' ratio, an index of diastolic dysfunction, was the best predictor of hospital mortality according to the area under the ROC curve (0.71) and was an independent predictor of outcome, as determined by multivariate analysis (OR = 1.36 [1.05 - 1.76], p = 0.02). In septic patients admitted to an intensive care unit, echocardiographic systolic dysfunction is not associated with increased mortality. In contrast, diastolic dysfunction is an independent predictor of outcome.