Winkelhorst Jurgen C, Bootsma Inge T, Koetsier Peter M, de Lange Fellery, Boerma Evert C
Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Department of Cardiothoracic Anaesthesiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Shock. 2020 May;53(5):537-543. doi: 10.1097/SHK.0000000000001413.
Sepsis-related myocardial dysfunction is associated with impaired outcome. Traditionally, in this setting the main focus has been on left ventricular performance. Currently, specific knowledge on the prognostic importance of right ventricular dysfunction is scarce. The aim of this study was to determine whether right ventricular ejection fraction (RVEF) is predictive of long-term mortality in sepsis.
Single-centre retrospective cohort study in adult patients admitted to the ICU with severe sepsis and septic shock, and equipped with a pulmonary artery catheter within the first day after admission. RVEF was recorded as an average over the first 24 h (sample rate of 1 per min). Patients were separated a priori into subgroups according to their RVEF: RVEF less than 20% (A), RVEF 20% to 30% (B), and RVEF more than 30% (C). The primary endpoint was 1-year all-cause mortality.
In a 7-year period, 101 patients fulfilled all entry criteria and 98 were included in the study. One-year all-cause mortality was significantly different between groups: 57% in group A (n = 21), 18% in group B (n = 55), and 23% in group C (n = 22); P = 0.003. Kaplan-Meier survival analysis revealed a clear separation between groups A and B/C (X = 14.00, P = 0.001). In a multivariate logistic regression analysis RVEF, both as a categorical variable (RVEF <20%) and as a continuous variable remained independently associated with the primary endpoint (odds ratio [OR] 4.1; 95% confidence interval [CI], 1.3-13.4; P = 0.018 and OR 0.92; 95% CI, 0.85-0.99; P = 0.018, respectively).
RVEF was independently associated with 1-year all-cause mortality in a highly selected group of patients with severe sepsis and septic shock.
脓毒症相关的心肌功能障碍与不良预后相关。传统上，在这种情况下，主要关注点一直是左心室功能。目前，关于右心室功能障碍预后重要性的具体知识很少。本研究的目的是确定右心室射血分数（RVEF）是否可预测脓毒症患者的长期死亡率。
对入住重症监护病房（ICU）的严重脓毒症和脓毒性休克成年患者进行单中心回顾性队列研究，这些患者在入院后第一天内配备了肺动脉导管。RVEF记录为最初24小时内的平均值（采样率为每分钟1次）。根据RVEF将患者预先分为亚组：RVEF小于20%（A组）、RVEF 20%至30%（B组）和RVEF大于30%（C组）。主要终点是1年全因死亡率。
在7年期间，101例患者符合所有纳入标准，98例纳入研究。各组间1年全因死亡率有显著差异：A组（n = 21）为57%，B组（n = 55）为18%，C组（n = 22）为23%；P = 0.003。Kaplan-Meier生存分析显示A组与B/C组之间有明显差异（X = 14.00，P = 0.001）。在多因素逻辑回归分析中，RVEF作为分类变量（RVEF <20%）和连续变量均与主要终点独立相关（比值比[OR] 4.1；95%置信区间[CI]，1.3 - 13.4；P = 0.018和OR 0.92；95% CI，0.85 - 0.99；P = 0.018，分别）。
在一组经过高度筛选的严重脓毒症和脓毒性休克患者中，RVEF与1年全因死亡率独立相关。
