Winkelhorst, J.C. (2019) Right ventricular function is predictive of long-term mortality in severe sepsis and septic shock. thesis, Medicine.
Full text available on request.Abstract
Background: Cardiac failure in sepsis is a common phenomenon associated with high mortality, yet still remains ill-defined. As of now, specific knowledge on the prognostic importance of right ventricular dysfunction is scarce. Aim: To determine whether right ventricular ejection fraction (RVEF) is predictive of longterm and short-term mortality in sepsis. Methods: Single-centre retrospective cohort study in adult patients with severe sepsis and septic shock, admitted to the Intensive Care Unit (ICU) and equipped with a pulmonary artery catheter within 24 hours following ICU admission. RVEF was recorded as an average over the first 24 hours (sample rate of 1 per minute). Patients were divided into 3 subgroups: RVEF<20% (A), RVEF 20-30% (B), and RVEF>30% (C). The primary endpoint was oneyear all-cause mortality. Secondary endpoints were ICU mortality and ICU morbidity. Results: Ninety-eight patients were included in the study. Kaplan-Meier survival analysis revealed one-year all-cause mortality was significantly higher in group A compared to the other groups (log rank p<0.001 and log rank p=0.022). In a multivariate logistic regression analysis both RVEF<20% and RVEF as a continuous variable, remained independently associated with the primary endpoint (OR 4.13; 95% CI 1.28-13.35; p=0.018 and OR 0.92; 95% CI 0.85-0.99; p=0.018). RVEF<20% was associated with higher rates of ICU mortality and multiple signs of circulatory failure, but did not influence length of stay on the ICU and duration of mechanical ventilation. Conclusion: RVEF is independently associated with one-year all-cause mortality in a highly selected group of septic patients. RVEF<20% is associated with a higher ICU mortality and circulatory failure.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor and Boerma, E.C. MD PhD Location Medical Centre Leeuwarden Dep |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/449 |
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