Introduction: Changes in left ventricular (LV) systolic function have been widely reported in the setting of sepsis. However, the clinical trajectory of systolic function in patients after recovery from sepsis is unclear. We aim to characterize the trajectory of LV function among septic ICU patients who survive the intensive care unit (ICU).
Methods: We conducted a single-center retrospective cohort study of adult patients with sepsis admitted to the ICU from 2001-2012 at Beth Israel Deaconess Medical Center, who had at least one echocardiogram done while in the ICU and at least one follow up echo as an outpatient. Sepsis was defined as meeting the Angus definition of sepsis or requiring vasopressors, but excluding those in cardiogenic shock, hemorrhagic shock or on hemodialysis. We compared measurements of LV systolic ejection fraction (EF) between the first ICU and outpatient echos. LV EF was annotated as normal, hyperdynamic, or depressed (mild, moderate, and severe). Recovery of LV EF was defined as a change from depressed toward normal or hyperdynamic, or from hyperdynamic to normal.
Results: Among 274 patients with an ICU echo followed by an outpatient echo, 182 had normal EF, 22 had mildly reduced EF, 17 had moderately reduced EF, 27 had severely reduced EF, and 26 had hyperdynamic EF. Of 92 patients with abnormal EF, 58 recovered (63%). Patients with hyperdynamic EF were significantly more likely to recover (p = 0.049), particularly among those with lower initial white blood cell (WBC) count (p=0.018). Among those with depressed EF (n=66), younger age was associated with recovery (p=0.048).
Conclusions: We find that hyperdynamic EF in septic ICU patients was likely to recover, particularly among patients with lower initial WBC count. Depressed EF in septic ICU patients was more likely to recover in younger patients. Further studies with larger sample sizes are needed to better understand the transient nature of systolic dysfunction from sepsis.