Vedant A Gupta1, Matthew Sousa2, Nathan Kraitman3, Rahul Annabathula4, Olga Vsevolozhskaya5, Steve W Leung6, Vincent L Sorrell7. 1. Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, 1000 S. Limestone, Lexington, KY 40536, USA. Electronic address: vedant.gupta@uky.edu. 2. Department of Internal Medicine, University of Kentucky, 1000 S. Limestone, Lexington, KY 40536, USA. Electronic address: matthew.sousa@uky.edu. 3. Department of Internal Medicine, University of Kentucky, 1000 S. Limestone, Lexington, KY 40536, USA. Electronic address: nkraitman@health.usf.edu. 4. College of Medicine, University of Kentucky, 1000 S. Limestone, Lexington, KY 40536, USA. Electronic address: rahul.annabathula@uky.edu. 5. Department of Biostatistics, University of Kentucky, 1000 S. Limestone, Lexington, KY 40536, USA. Electronic address: ovs222@uky.edu. 6. Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, 1000 S. Limestone, Lexington, KY 40536, USA. Electronic address: steve.leung@uky.edu. 7. Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, 1000 S. Limestone, Lexington, KY 40536, USA. Electronic address: v.sorrell@uky.edu.
Abstract
PURPOSE: Sepsis is a highly prevalent and fatal condition, with reported cardiovascular event rates as high as 25-30% at 1year. Risk stratification in septic patients has been extremely limited. MATERIAL AND METHODS: 267 septic patients with detectable troponin levels, APACHE II scores, and CT scans of the chest or abdomen were assessed. Patients with a recent cardiac intervention were excluded. Coronary artery calcification (CAC) was identified as present or absent on body CT scans. Cardiovascular death, acute myocardial infarction (AMI), or PCI at 1year was assessed using multivariate logistic regression analysis. RESULTS: Patients with CAC were older, predominantly male with more risk factors for coronary disease, but similar peak troponin levels and APACHE II scores. In a multivariate analysis, CAC was predictive of the primary outcome (OR 6.827; 95% CI 1.336-54.686; p=0.037). Patients with no CAC, history of CHF or CKD were at low risk (<1%) for cardiovascular complications at 1year even at very high troponin levels (<8.0ng/dL). CONCLUSION: CAC risk stratifies septic patients for cardiovascular complications better than traditional risk factors and can be identified on body CT scans. This novel, risk stratifying framework built on CAC can help guide individualized management of septic patients.
PURPOSE:Sepsis is a highly prevalent and fatal condition, with reported cardiovascular event rates as high as 25-30% at 1year. Risk stratification in septic patients has been extremely limited. MATERIAL AND METHODS: 267 septic patients with detectable troponin levels, APACHE II scores, and CT scans of the chest or abdomen were assessed. Patients with a recent cardiac intervention were excluded. Coronary artery calcification (CAC) was identified as present or absent on body CT scans. Cardiovascular death, acute myocardial infarction (AMI), or PCI at 1year was assessed using multivariate logistic regression analysis. RESULTS:Patients with CAC were older, predominantly male with more risk factors for coronary disease, but similar peak troponin levels and APACHE II scores. In a multivariate analysis, CAC was predictive of the primary outcome (OR 6.827; 95% CI 1.336-54.686; p=0.037). Patients with no CAC, history of CHF or CKD were at low risk (<1%) for cardiovascular complications at 1year even at very high troponin levels (<8.0ng/dL). CONCLUSION: CAC risk stratifies septic patients for cardiovascular complications better than traditional risk factors and can be identified on body CT scans. This novel, risk stratifying framework built on CAC can help guide individualized management of septic patients.
Authors: Leah B Kosyakovsky; Federico Angriman; Emma Katz; Neill K Adhikari; Lucas C Godoy; John C Marshall; Bruno L Ferreyro; Douglas S Lee; Robert S Rosenson; Naveed Sattar; Subodh Verma; Augustin Toma; Marina Englesakis; Barry Burstein; Michael E Farkouh; Margaret Herridge; Dennis T Ko; Damon C Scales; Michael E Detsky; Lior Bibas; Patrick R Lawler Journal: Intensive Care Med Date: 2021-08-09 Impact factor: 17.440