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

Purpose: To investigate the predictive value of left ventricular-arterial coupling (VAC) for clinical prognosis of elderly patients with septic shock. Materials and methods: This 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. Results: Compared with non-survivors, survivors had a significantly lower Ea/Ees ratio (P < 0.01), mainly because survivors had higher Ees values (P < 0.01), butwithout 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). Themultivariate 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. Conclusions: Left VAC has prognostic value in elderly patients with septic shock. (c) 2017 Published by Elsevier Inc.