Impact of left ventricular function on tissue perfusion and renal outcomes in patients with sepsis
- 1 May 2021
- journal article
- research article
- Published by Dustri-Verlgag Dr. Karl Feistle in Clinical Nephrology
- Vol. 95 (5), 247-255
- https://doi.org/10.5414/cn110382
Abstract
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.Keywords
This publication has 34 references indexed in Scilit:
- Better lactate clearance associated with good neurologic outcome in survivors who treated with therapeutic hypothermia after out-of-hospital cardiac arrestCritical Care, 2013
- KDIGO Clinical Practice Guidelines for Acute Kidney InjuryNephron Clinical Practice, 2012
- Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: A pilot studyAcute Cardiac Care, 2012
- Predictors of Acute Kidney Injury in Septic Shock PatientsClinical Journal of the American Society of Nephrology, 2011
- The severity of acute kidney injury predicts progression to chronic kidney diseaseKidney International, 2011
- Clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction at admission: a descriptive studyCritical Care, 2010
- Discontinuation of continuous renal replacement therapy: A post hoc analysis of a prospective multicenter observational study*Critical Care Medicine, 2009
- Cardiorenal SyndromeJournal of the American College of Cardiology, 2008
- Actual incidence of global left ventricular hypokinesia in adult septic shockCritical Care Medicine, 2008
- Serum Lactate as a Predictor of Mortality in Emergency Department Patients with InfectionAnnals of Emergency Medicine, 2005