Early Characteristics of Circulation in Patients with Poor Outcome of Abdominal Sepsis (Preliminary Report)

Abstract

Aim: to study characteristics of the central hemodynamics (CHD) in patients with severe abdominal sepsis with different outcomes of the disease.Materials and Methods. 18 patients with abdominal sepsis, aged 50.2±3, with the APACHE II and SOFA severity scoring of 13.7±0.8 and 8.4±0.5, respectively, were enrolled in the retrospective study. The CHD was studied using the transpulmonary thermodilution. The following groups were identified: Group 1 (deceased, n=9) and Group 2 (survivors, n=9). The groups did not differ (P>0.05) in age, sex, and the severity of the condition at admission to the ICU. The significance of differences was assessed using the t-test and the chi-squared test. The prognostic value of the parameters was studied using the ROC analysis.Results. On Day 1, the intergroup differences included the average blood pressure (BPav) (85.3±3.3 and 101.6±4.6 mmHg, respectively (P<0.05)) and the cardiac power index (CPI) (306±22 and 429.9±48.9 W/m2, respectively) (Р<0.05). The intergroup difference in the CPI and the global ejection fraction (GEF) persisted on Day 3: 22.3±2.3 and 29.3±1.5%, respectively (P<0.05); there was no other difference. The intergroup difference in the GEF remained on Day 5. On Day 7, the CHD parameters demonstrated no intergroup difference. The SOFA severity scoring in Group 1 patients became greater than that in Group 2 starting from Day 5. According to ROC analysis, BPav (95 mmHg, sensitivity: 88.9%, specificity: 88.9%), CPI (373 W/m2, sensitivity: 88.9%, specificity: 77.8%), and GEF (26.1%, sensitivity: 66.7%, specificity: 77,8%) were the most important predictors of the lethal outcome on Days 1—3 (areas under ROC curves: 0.765—0.840; P<0.05). On days 5—7, the SOFA scoring >7 (sensitivity: 88.9%, specificity: 88.9%) was the most important predictor of the lethal outcome (areas under ROC curves: 0.957—0.994; P<0.05).Conclusion: during the first five days of the intensive treatment of severe sepsis in patients with unfavorable prognosis, a moderate decrease in the cardiac power index and overall cardiac systolic function was registered. The prognostic significance of such parameters as CPI and GEF may become obvious within the first 3 days of the intensive treatment.

Keywords

• abdominal sepsis
• septic cardiopathy
• predictors of mortality in sepsis
• central hemodynamics in sepsis