Disfunción miocárdica y su utilidad pronóstica en sepsis y choque séptico / Myocardial dysfunction and its prognostic utility in sepsis and septic shock

Introducción: la sepsis es una disfunción orgánica poten- cialmente mortal que está asociada a una infección; tiene alta morbilidad y mortalidad. La disfunción miocárdica aso- ciada a sepsis es frecuente y se asocia con desenlaces desfavorables. Objetivo: describir la distribución de la disfunción miocárdica por ecocardiografía transtorácica y estimar su utilidad pronóstica en sepsis y choque séptico. Material y métodos: estudio de cohorte multicéntrico prospectivo, realizado en cuatro centros de referencia de Bucaramanga y su área metropolitana. Se incluyeron 271 pacientes con diagnóstico de sepsis y choque séptico, a quienes se les realizó ecocardiograma transtorácico y se les dio seguimiento por 30 días. Resultados: no hubo diferencias en la fracción de eyección del ventrículo izquierdo entre sobrevivientes a los 30 días y no sobrevivientes. Se registraron 51 pacientes (48.7%) con disfunción diastólica grado I, 14.5% con disfunción grado II y 36.75% con disfunción grado III. Los pacientes con disfunción diastólica grado I tuvieron una mortalidad más alta que aquellos con disfunción diastólica de grado II (p = 0.023). Conclusiones: la mayor mortalidad registrada en la disfunción diastólica grado I sugiere que los pacientes con bajas presiones de llenado tienen peores desenlaces. Por otra parte, la fracción de eyección del ventrículo izquierdo por sí sola no se relaciona con mayor mortalidad en sepsis.

Background: Sepsis is a potentially mortal infection which is related to multiple organ dysfunction; it has a high morbidity and mortality. Myocardial dysfunction is frequent in sepsis and it is related to unfavorable outcomes. Objective: To describe by transthoracic echocardiography the clinical distribution of myocardial dysfunction in sepsis and septic shock and estimate its prognostic utility. Material and methods: Cross-sectional study based on a multi-centric prospective cohort study in 4 reference centers in Bucaramanga, Colombia, and its metropolitan area. 271 patients with sepsis and septic shock were included; they underwent standard transthoracic echocardiography and a 30-day follow-up. Results: There was no difference in the left ventricular ejection fraction (p = 0.061) between survivors and non-survivors. 51 patients (48.71%) had grade I diastolic dys-function, 48 patients (14.52%) had grade II dysfunction and 21 patients (36.75%) had grade III diastolic dysfunction. Mortality was higher in patients with grade I diastolic dysfunction when compared to those with grade II dysfunction (p = 0.023). Conclusions: The higher mortality in grade I diastolic dysfunction suggests that patients with low filling pressures have worst outcomes. On the other hand, left ventricular ejection fraction per se is not associated with a higher mortality in sepsis.

[Myocardial dysfunction and its prognostic utility in sepsis and septic shock]. / Disfunción miocárdica y su utilidad pronóstica en sepsis y choque séptico.

BACKGROUND: Sepsis is a potentially mortal infection which is related to multiple organ dysfunction; it has a high morbidity and mortality. Myocardial dysfunction is frequent in sepsis and it is related to unfavorable outcomes. Objective: To describe by transthoracic echocardiography the clinical distribution of myocardial dysfunction in sepsis and septic shock and estimate its prognostic utility. MATERIAL AND METHODS: Cross-sectional study based on a multi-centric prospective cohort study in 4 reference centers in Bucaramanga, Colombia, and its metropolitan area. 271 patients with sepsis and septic shock were included; they underwent standard transthoracic echocardiography and a 30-day follow-up. RESULTS: There was no difference in the left ventricular ejection fraction (p = 0.061) between survivors and non-survivors. 51 patients (48.71%) had grade I diastolic dysfunction, 48 patients (14.52%) had grade II dysfunction and 21 patients (36.75%) had grade III diastolic dysfunction. Mortality was higher in patients with grade I diastolic dysfunction when compared to those with grade II dysfunction (p = 0.023). CONCLUSIONS: The higher mortality in grade I diastolic dysfunction suggests that patients with low filling pressures have worst outcomes. On the other hand, left ventricular ejection fraction per se is not associated with a higher mortality in sepsis.

INTRODUCCIÓN: la sepsis es una disfunción orgánica potencialmente mortal que está asociada a una infección; tiene alta morbilidad y mortalidad. La disfunción miocárdica asociada a sepsis es frecuente y se asocia con desenlaces desfavorables. OBJETIVO: describir la distribución de la disfunción miocárdica por ecocardiografía transtorácica y estimar su utilidad pronóstica en sepsis y choque séptico. MATERIAL Y MÉTODOS: estudio de cohorte multicéntrico prospectivo, realizado en cuatro centros de referencia de Bucaramanga y su área metropolitana. Se incluyeron 271 pacientes con diagnóstico de sepsis y choque séptico, a quienes se les realizó ecocardiograma transtorácico y se les dio seguimiento por 30 días. RESULTADOS: no hubo diferencias en la fracción de eyección del ventrículo izquierdo entre sobrevivientes a los 30 días y no sobrevivientes. Se registraron 51 pacientes (48.7%) con disfunción diastólica grado I, 14.5% con disfunción grado II y 36.75% con disfunción grado III. Los pacientes con disfunción diastólica grado I tuvieron una mortalidad más alta que aquellos con disfunción diastólica de grado II (p = 0.023). CONCLUSIONES: la mayor mortalidad registrada en la disfunción diastólica grado I sugiere que los pacientes con bajas presiones de llenado tienen peores desenlaces. Por otra parte, la fracción de eyección del ventrículo izquierdo por sí sola no se relaciona con mayor mortalidad en sepsis.

Prognostic Value of MMP-9 -1562 C/T Gene Polymorphism in Patients With Sepsis.

INTRODUCTION: Matrix metalloproteinase-9 (MMP-9) plays an important role in the pathophysiology of sepsis. A single-nucleotide polymorphism (SNP) at position -1562 (C/T) in the MMP-9 gene has been associated with differential MMP-9 expression, being higher when the -1562 T allele is present. We evaluated the association of the SNP MMP9 -1562 C/T with severity and mortality in patients with sepsis to establish whether the prognosis of the disease is affected. MATERIALS AND METHODS: A case-control study exploratory was carried out in a cohort of infected patients. 540 individuals were selected in total, 270 patients with sepsis and 270 controls (infected but non-septic), classified according to the 2016 consensus (Sepsis-3). The presence of the single-nucleotide polymorphism (SNP; allele T and/or allele C) was determined through analyses of restriction fragment length polymorphism and plasma levels of MMP-9 were determined through enzyme-linked immunosorbent assay immunoassay. RESULTS: SNP MMP-9 -1562 has two known alleles (T and C), with predominance of the C over the T allele; in the group of patients with sepsis, T allele was found in 7.2% of cases, while C allele in the rest (92.8%); in comparison, in the group of infected but non-septic patients, frequencies were 9.4% for T allele and 90.6% for the C allele (P = .33). Also, the presence of the polymorphic T allele was not related to the levels of MMP-9 in patients with sepsis in comparison with infected but non-septic patients 780 (397-1375) ng/mL vs 646 (172-1249) ng/mL (P = .64). There was also no association between the SNP and sepsis mortality (P = .78). CONCLUSIONS: We concluded that there was no association between the SNP MMP9 -1562 C/T and sepsis or between the SNP MMP9 -1562 C/T and sepsis mortality in the Northeastern Colombian septic patient cohort. Further research is needed to clarify the correlation among sepsis, genetic factors with allele T and MMP-9 plasma concentration.