title: Diastolic dysfunction and mortality in severe sepsis and septic shock.
abstract: OBJECTIVE
  Systolic dysfunction in septic shock is well recognized and, paradoxically, predicts better outcome. In contrast, diastolic dysfunction is often ignored and its role in determining early mortality from sepsis has not been adequately investigated.
  
  
  RESULTS
  A cohort of 262 intensive care unit patients with severe sepsis or septic shock underwent two echocardiography examinations early in the course of their disease. All clinical, laboratory, and survival data were prospectively collected. Ninety-five (36%) patients died in the hospital. Reduced mitral annular e'-wave was the strongest predictor of mortality, even after adjusting for the APACHE-II score, low urine output, low left ventricular stroke volume index, and lowest oxygen saturation, the other independent predictors of mortality (Cox's proportional hazards: Wald = 21.5, 16.3, 9.91, 7.0 and 6.6, P< 0.0001, <0.0001, 0.002, 0.008, and 0.010, respectively). Patients with systolic dysfunction only (left ventricular ejection fraction ≤50%), diastolic dysfunction only (e'-wave <8 cm/s), or combined systolic and diastolic dysfunction (9.1, 40.4, and 14.1% of the patients, respectively) had higher mortality than those with no diastolic or systolic dysfunction (hazard ratio = 2.9, 6.0, 6.2, P= 0.035, <0.0001, <0.0001, respectively) and had significantly higher serum levels of high-sensitivity troponin-T and N-terminal pro-B-type natriuretic peptide (NT-proBNP). High-sensitivity troponin-T was only minimally elevated, whereas serum levels of NT-proBNP were markedly elevated [median (inter-quartile range): 0.07 (0.02-0.17) ng/mL and 5762 (1001-15 962) pg/mL, respectively], though both predicted mortality even after adjusting for highest creatinine levels (Wald = 5.8, 21.4 and 2.3, P= 0.015, <0.001 and 0.13).
  
  
  CONCLUSIONS
  Diastolic dysfunction is common and is a major predictor of mortality in severe sepsis and septic shock.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Jerusalem 91120, Israel. gio@cc.huji.ac.il
authors.forename: Giora
authors.initials: G
authors.lastname: Landesberg
authors.forename: Dan
authors.initials: D
authors.lastname: Gilon
authors.forename: Yuval
authors.initials: Y
authors.lastname: Meroz
authors.forename: Milena
authors.initials: M
authors.lastname: Georgieva
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levin
authors.forename: Sergey
authors.initials: S
authors.lastname: Goodman
authors.forename: Alexander
authors.initials: A
authors.lastname: Avidan
authors.forename: Ronen
authors.initials: R
authors.lastname: Beeri
authors.forename: Charles
authors.initials: C
authors.lastname: Weissman
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D004452:Echocardiography; D005260:Female; D054144:Heart Failure, Diastolic / Q000097:blood / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000401:mortality*; D012772:Shock, Septic / Q000097:blood / Q000209:etiology / Q000401:mortality; D020107:Troponin T / Q000378:metabolism; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000401:mortality*
chemical_list: D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain