title: Severity of cardiac impairment in the early stage of community-acquired sepsis determines worse prognosis.
abstract: BACKGROUND
  In sepsis, the reduced systemic vascular resistance (SVR) can lead to a compensatory increase in cardiac output (CO). This may mimic a normal cardiac function although there is already a sepsis-induced myocardial depression. On a cohort of patients with septic multi-organ dysfunction syndrome, we have recently developed a method to correlate the actual CO to the afterload (estimated by SVR) and introduced the parameter "afterload-related cardiac performance" (ACP), which indicates if the rise of CO is adequate for the particular SVR. In this present study it was to be investigated, if ACP can reveal septic cardiomyopathy in patients with community-acquired sepsis in the early state soon after admission to the emergency department (ED), and if there is a prognostic relevance of septic cardiomyopathy defined by ACP. Results were compared to cardiac index (CI) and cardiac power index (CPI).
  
  
  METHODS
  Adults presenting at the ED with sepsis were included. ACP, CI and CPI were calculated at the time of admission, after 24, and 72 h. They were correlated to severity of disease and the prognostic values were analyzed.
  
  
  RESULTS
  A total of 141 patients were included. Only ACP was significantly influenced by severity of sepsis, whereas CI and CPI were not. ACP was the only hemodynamic parameter predicting mortality: nonsurvivors had lower ACP values at the time of admission to the ED (66.9 vs. 88.9 %, p < 0.05) and ACP predicted non-survival with an AUC value of 0.72, p = 0.003. Cardiac impairment defined by an ACP value of 80 % or below determined worse prognosis.
  
  
  CONCLUSIONS
  Septic cardiomyopathy occurs already at the early stage of disease and is of prognostic relevance. It might be recognized best, if cardiac function is correlated to afterload.
authors.affiliation: Department of Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany, joachim.wilhelm@uk-halle.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Wilhelm
authors.forename: Stefan
authors.initials: S
authors.lastname: Hettwer
authors.forename: Markus
authors.initials: M
authors.lastname: Schuermann
authors.forename: Silke
authors.initials: S
authors.lastname: Bagger
authors.forename: Franziska
authors.initials: F
authors.lastname: Gerhardt
authors.forename: Sandra
authors.initials: S
authors.lastname: Mundt
authors.forename: Susanne
authors.initials: S
authors.lastname: Muschik
authors.forename: Julia
authors.initials: J
authors.lastname: Zimmermann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bubel
authors.forename: Mroawan
authors.initials: M
authors.lastname: Amoury
authors.forename: Thomas
authors.initials: T
authors.lastname: Kloess
authors.forename: Rainer
authors.initials: R
authors.lastname: Finke
authors.forename: Harald
authors.initials: H
authors.lastname: Loppnow
authors.forename: Ursula
authors.initials: U
authors.lastname: Mueller-Werdan
authors.forename: Henning
authors.initials: H
authors.lastname: Ebelt
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
mesh_terms: D000368:Aged; D002302:Cardiac Output / Q000502:physiology*; D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology*; D017714:Community-Acquired Infections / Q000503:physiopathology*; D004636:Emergency Service, Hospital; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000503:physiopathology*; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors