Factors associated with left ventricular diastolic dysfunction in patients with septic shock.

PURPOSE: To investigate risk factors associated with left ventricular diastolic dysfunction (LVDD) of patients with septic shock.

MATERIALS AND

METHODS

Patients with septic shock concomitant with or without LVDD were retrospectively enrolled and divided into the LVDD group (n = 17) and control without LVDD (n = 85). The clinical and ultrasound data were analyzed.

RESULTS

A significant (P < 0.05) difference existed between the two groups in serum creatinine, APACHE II score, serum glucose, triglyceride, BUN, FT4, LAVI, mitral E, average e', E/average e', septal e', septal e'/septal s', E/septal e', lateral s', lateral e', and E/lateral e'. LAVI > 37 mL/m2, septal e' < 7 cm/s (OR 11.04, 95% CI 3.38-36.05), septal e'/septal s' < 0.8 (OR 4.09, 95% CI 1.37-12.25), E/septal e' > 15 (OR 22.86, 95% CI 6.09-85.79), lateral e' < 8 cm/s (OR 9.16, 95% CI 2.70-31.07), E/lateral e' > 13 (OR 52, 95% CI 11.99- 225.55), lateral s' < 10 (OR 3.36, 95% CI 1.13-9.99), average e' > 10, E/average e' > 10 (OR 9.53, 95% CI 2.49-36.46), APACHE II score > 16 (OR 3.33, 95% CI 1.00-11.03), SOFA > 5 (or 3.43, 95% CI 1.11-10.60), BUN > 12 mmol/L (OR 3.37, 95% CI 1.15-9.87), serum creatinine > 146 μmol/L (OR 5.08, 95% CI 1.69-15.23), serum glucose > 8 mmol/L (OR 3.36, 95% CI 1.09-10.40), and triglyceride > 1.8 mmol/L were significant (P < 0.05) risk factors for LVDD. LAVI > 37 ml/m2, lateral e' < 8 cm/s, E/lateral e' > 13, and SOFA > 5 were significant (P < 0.05) independent risk factors for LVDD. ROC curve analysis demonstrated that the cut-off value and AUC were 37.09 mL/m2 and 0.85 for LAVI, 8.00 cm/s and 0.89 for lateral e', 12.86 and 0.82 for E/lateral e', and 5.00 and 0.69 for SOFA, respectively.

CONCLUSION

Left atrial volume index, mitral lateral e', E/lateral e', and SOFA score are significant independent risk factors for predicting left ventricular diastolic dysfunction in patients with septic shock.