Diastolic Dysfunction in Septic Patients in Correlation with Renal Function
Sabry A. Omar, Msc, Mohamed Elshafey, MD, Khalid Toema, MD, and Rania El-Hoseiny, MD
Critical Care Medicine Department, Faculty of Medicine, CairoUniversity, Cairo, Egypt
Abstract:: Septic shock remains one of the most challenging medical conditions, with increasing incidence over the last years. One of the most important features of sepsis is myocardial dysfunction and renal impairment. Objective is to evaluate diastolic dysfunction in patient with septicemia and detect its relationto renal impairment in this subset of patients. Methods The study was conducted on 40 patients diagnosed to have various degrees of systemic sepsis admitted to Intensive Care Unit of Mansoura International Specialized Hospital.After exclusion of patients with structural heart diseases and renal impairment, each patient was subjected to the following: Full clinical evaluation, complete laboratory investigation -including serum troponin I &creatinine levels- and echocardiographic evaluation with measuring of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), calculation of LVEF& assessment of diastolic function measuring mitral annulus E/A ratio, E deceleration time(DT)& isovolumic relaxation time (IVRT) ResultsA non -randomized non-controlled prospective study done between July 2009 to August 2010. The study included 40 patients, 24 males & 16 females, with mean age of 62±12. Renal impairment (defined as serum creatinine > 1.4 mg/dl following a normal creatinine level on admission associated with oliguria <0.5 ml/kg/6hours)was present in 78% (31 pts). These pts had significantly shorter IVRT & shorter DT than those with normal renal function. LVEDD and LVESD were significantly larger&LVEF was significantly lower in pts with renal impairment. Renal impairment was associated with significantly lower hemoglobin, higher liver enzymes, higher bilirubin and higher troponin levels. Eighteen patients had SIRS & sepsis (group A, 45%) & 22 had septic shock (group B, 55%). Patients with septic shock showed significantly higher creatinine & significantly higher troponin level than pts with sepsis.Regarding ventricular functions, LVEDD and LVESD were significantly larger&LVEF was significantly lower in septic shock ptsthan pts with SIRS & sepsis. In group B, both DT and IVRT were significantly shorter than group A.Overallmortality was 55% (100% in septic shock versus 0% in pts with SIRS & sepsis). ConclusionThe presence of renal impairment was associated with a more severe form of diastolic & systolic dysfunction in septic patients. Septic shock patients, showed larger ventricular dimensions and significant systolic and diastolic dysfunctions than patients with sepsis. Higher evidence of myocardial injury in septic shock.
[Sabry A. Omar, Mohamed Elshafey; Khalid Toema and Rania El-Hoseiny. Diastolic Dysfunction in Septic Patients in Correlation with Renal Function. Life Sci J 2012;9(1):572-579]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 85
Key Words: Diastolic dysfunction, septic patients, renal function Full Text 85