Impact of left ventricular function on tissue perfusion and renal outcomes in patients with sepsis

초록

Aims: Left ventricular (LV) dysfunction is a predictor of mortality in patients with sepsis. However, it remains uncertain whether LV dysfunction aggravates tissue perfusion, leading to organ failure, or whether it has an independent impact. We investigated the association between LV dysfunction and tissue perfusion, and their impacts on renal outcomes in patients with sepsis. Materials and methods: We retrospectively reviewed 162 adult patients with sepsis who met the Sepsis-3 definition, including 83 (51.2%) with normal LV function, 39 (24.1%) with diastolic dysfunction (septal E/e' ratio > 15 with ejection fraction >= 50%), and 40 (24.7%) with systolic dysfunction (ejection fraction < 50%). Tissue perfusion was assessed using blood lactate levels. Results: LV function was not associated with the initial lactate level, 24-hour lactate level, and lactate clearance (p = 0.861, 0.907, 0.363). However, acute kidney injury risk increased with blood lactate levels >= 2 mmol/L or systolic dysfunction in multivariate analysis (p = 0.032 and 0.090). The probability of renal replacement therapy did not depend on both blood lactate levels and LV function, conversely, the renal replacement therapy-free period was shorter in patients with LV dysfunction, independent of previous chronic kidney disease (p = 0.003). Renal function at discharge was not significantly related to lactate levels and LV function (p = 0.688 and 0.174). Conclusion: LV dysfunction might not influence tissue perfusion but could have unfavorable impacts on renal outcomes in patients with sepsis. Besides treatment for preserving tissue perfusion, individualized therapies tailored to LV function are needed.

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