Jing Yan1, Xiaoyang Zhou1, Bangchuan Hu2, Shijin Gong1, Yihua Yu1, Guolong Cai1, Li Li3. 1. Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China. 2. Intensive Care Unit, Zhejiang Provincial People's Hospital, Hangzhou 310014, China. 3. Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China. Electronic address: lilihbch@163.com.
Abstract
PURPOSE: To investigate the predictive value of left ventricular-arterial coupling (VAC) for clinical prognosis of elderly patients with septic shock. MATERIALS AND METHODS: This was a single-center prospective cohort study of 63 elderly patients with septic shock treated between August 2014 and January 2016 at the 30-bed intensive care unit (ICU) of Zhejiang Hospital (China). Left VAC was evaluated by transthoracic echocardiography (TTE). End-systolic elastance (Ees) and left ventricular ejection fraction (LVEF) were measured; arterial elastance (Ea) was calculated. The 28-day survival was evaluated. RESULTS: Compared with non-survivors, survivors had a significantly lower Ea/Ees ratio (P<0.01), mainly because survivors had higher Ees values (P<0.01), but without difference in Ea (P=0.720). LVEF was greater (47.5±7.3 vs. 43.6±6.4, P=0.03); LVESV was smaller in survivors compared to non-survivors (P<0.05). The multivariate Cox proportional regression analysis showed that APACHEII scores (hazard ratio (HR)=1.12, 95% confidence interval (95%CI):1.01-1.25, P=0.04), blood lactate levels (HR=1.21, 95%CI:1.07-1.36, P=0.002), and VAC (HR=2.57, 95%CI:1.29-5.13, P=0.007) were independently associated with 28-day mortality of elderly patients with septic shock. The optimal cutoff point of VAC for predicting 28-day mortality was 2.14 with 56.7% sensibility and 87.9% specificity; the area under the curve was 0.74. CONCLUSIONS: Left VAC has prognostic value in elderly patients with septic shock.
PURPOSE: To investigate the predictive value of left ventricular-arterial coupling (VAC) for clinical prognosis of elderly patients with septic shock. MATERIALS AND METHODS: This was a single-center prospective cohort study of 63 elderly patients with septic shock treated between August 2014 and January 2016 at the 30-bed intensive care unit (ICU) of Zhejiang Hospital (China). Left VAC was evaluated by transthoracic echocardiography (TTE). End-systolic elastance (Ees) and left ventricular ejection fraction (LVEF) were measured; arterial elastance (Ea) was calculated. The 28-day survival was evaluated. RESULTS: Compared with non-survivors, survivors had a significantly lower Ea/Ees ratio (P<0.01), mainly because survivors had higher Ees values (P<0.01), but without difference in Ea (P=0.720). LVEF was greater (47.5±7.3 vs. 43.6±6.4, P=0.03); LVESV was smaller in survivors compared to non-survivors (P<0.05). The multivariate Cox proportional regression analysis showed that APACHEII scores (hazard ratio (HR)=1.12, 95% confidence interval (95%CI):1.01-1.25, P=0.04), blood lactate levels (HR=1.21, 95%CI:1.07-1.36, P=0.002), and VAC (HR=2.57, 95%CI:1.29-5.13, P=0.007) were independently associated with 28-day mortality of elderly patients with septic shock. The optimal cutoff point of VAC for predicting 28-day mortality was 2.14 with 56.7% sensibility and 87.9% specificity; the area under the curve was 0.74. CONCLUSIONS: Left VAC has prognostic value in elderly patients with septic shock.