Diastolic Dysfunction in Sepsis and Septic Shock: Which Parameters are Most Predictive?

Background: Despite strong correlation between diastolic dysfunction and mortality in patients with sepsis, there is a wide range of discrepancy involving which echocardiographic parameters are most sensitive and predictive. Methods: Seventy patients with sepsis were enrolled. Patients were stratified according to their systolic and diastolic functions into 4 groups. Prognosis was compared between the different groups. Different diastolic parameters were measured. Logistic regression analysis was used to determine which parameters are most predictive for poor prognosis. Results: Mortality was significantly higher (68.4%) in patients who had combined systolic and diastolic dysfunction compared with other patients (p value <0.001). In addition, they had a higher incidence (36.8%) of developing acute kidney injury with a subsequent need for renal replacement therapy (P value: 0.008). Using multivariate regression analysis, E/A ratio and septal e ' are independent risk factors of mortality, with odds ratios 4.358 and 0.169 and P values 0.026 and 0.001, respectively. Using the receiver-operating characteristic curve, the cutoff values for these 2 parameters were 1.985 and 7.25 cm/sec, with areas under the curve 0.766 and 0.927, respectively. Conclusion: Septic patients with combined systolic and diastolic dysfunction had a higher incidence of mortality. Both E/A and septal e ' can predict mortality in these patients.