Risk factors for postoperative sepsis-induced cardiomyopathy in patients undergoing general thoracic surgery: a single center experience

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Abstract

Background

The current study aimed to investigate the incidence of sepsis-induced cardiomyopathy (SICM) in patients who received general thoracic surgery, along with the risk factors and management strategies for this complication.

Methods

The clinical records of 163 patients with postoperative sepsis were retrospectively reviewed. After propensity score matching, 144 patients were divided into 2 groups by stroke volume: the SICM group (n=72) and the non-SICM group (n=72).

Results

The overall incidence of postoperative SICM was 53.99%. Multiple logistic regression analysis showed that stroke volume and C-reactive protein were independent predictors of mortality in patients with postoperative sepsis. Statistical analysis by t-test and χ ² test indicated that mortality (P=0.000), B-type natriuretic peptide (P=0.001), left ventricular ejection fraction (P=0.000), the mitral peak velocity of early filling/early diastolic mitral annular velocity (E/e’) (P=0.049), C-reactive protein (P=0.016), procalcitonin (P=0.013), serum creatinine (P=0.016), platelets (P=0.028), and lactic acid (P=0.002) were significantly associated with the occurrence of postoperative SICM. Among these parameters, B-type natriuretic peptide was identified as the best biomarker for predicting SICM by receiver operating characteristic (ROC) curve analysis.

Conclusions

It is vital to improve the diagnosis and standard management of SICM. A combined strategy comprising early detection of suspected infection, adequate use of antibiotics, close monitoring, effective drainage, and supportive care may improve the outcomes of patients with postoperative SICM.

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Most cited references 27

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The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour … (2016)

Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.

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Time to Treatment and Mortality during Mandated Emergency Care for Sepsis.

Christopher W Seymour, Foster C Gesten, Hallie C Prescott … (2017)

Background In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. Methods We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care for patients with sepsis (i.e., blood cultures, broad-spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3-hour bundle and risk-adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. Results Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3-hour bundle completed within 3 hours. The median time to completion of the 3-hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3-hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk-adjusted in-hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). Conclusions More rapid completion of a 3-hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk-adjusted in-hospital mortality. (Funded by the National Institutes of Health and others.).

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The Epidemiology of Sepsis in Chinese ICUs: A National Cross-Sectional Survey

Jianfeng Xie, Hongliang Wang, Yan Mei Kang … (2020)

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Author and article information

Journal

Journal ID (nlm-ta): J Thorac Dis

Journal ID (iso-abbrev): J Thorac Dis

Journal ID (publisher-id): JTD

Title: Journal of Thoracic Disease

Publisher: AME Publishing Company

ISSN (Print): 2072-1439

ISSN (Electronic): 2077-6624

Publication date (Print and electronic): April 2021

Publication date (Print): April 2021

Volume: 13

Issue: 4

Pages: 2486-2494

Affiliations

[1 ]deptDepartment of Cardiology, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai, China;

[2 ]deptDepartment of Intensive Care Medicine, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai, China;

[3 ]deptDepartment of Pharmacy, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai, China

Author notes

Contributions: (I) Conception and design: Y Wang, B He, K Yu; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: Z Min, M Zhu; (V) Data analysis and interpretation: Y Pan, Y Wang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Ben He. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 10th Floor, No. 5 Building, No. 241, West Huai Hai Rd, Xuhui District, Shanghai, China. Email: heben241@ 123456126.com ; Kaiyan Yu. Department of Intensive Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 2rd Floor, No. 2 Building, No. 241, West Huai Hai Rd, Xuhui District, Shanghai, China. Email: kyy20@ 123456163.com .

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ORCID: 0000-0003-1923-1477.

Article

Publisher ID: jtd-13-04-2486

DOI: 10.21037/jtd-21-492

PMC ID: 8107539

PubMed ID: 34012595

SO-VID: f4084d9c-d505-416b-bfe8-7c99e3d42851

License:

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

Risk factors for postoperative sepsis-induced cardiomyopathy in patients undergoing general thoracic surgery: a single center experience

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Abstract

Background

Methods

Results

Conclusions

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Cardiovascular Innovations and Applications

Most cited references 27

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Time to Treatment and Mortality during Mandated Emergency Care for Sepsis.

The Epidemiology of Sepsis in Chinese ICUs: A National Cross-Sectional Survey

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