Cardiac Power Output Predicts Mortality in Septic Patients Matthew I. Saleem1, Eli Harris MD2, Tashina Dussie DO3, Ashley Roper MD2, Amgad N. Makaryus MD1,2,3, Roman Zeltser MD1,2,3 1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Uniondale, NY, 2Nassau University Medical Center, East Meadow, NY, 3Northwell Health, Manhasset, NY
Results
Background • • • •
Patient Characteristics
Sepsis related myocardial depression is associated with left and right side heart dysfunction Cardiogenic shock mortality has been associated with various hemodynamic parameters Echocardiography is a non-invasive method to evaluate cardiac function Cardiac Power Output (CPO) is a hemodynamic measurement that accounts for pumping capacity of the heart
Hypothesis • Cardiac power output is inversely proportional to mortality in septic patients.
Methods • • • • • •
Conclusions
Retrospective chart review of patients admitted between January 2014 and December 2018 with sepsis that underwent transthoracic echocardiogram Hemodynamic parameters were obtained using Siemans Synco Dynamics for echocardiography CPO was calculated as Mean Arterial Pressure X Cardiac Output/451 Binary logistic regression was used to calculated odds ratio for variables Cox proportional hazard ratio was used to calculate hazard ratio for variables All data analysis was done using IBM SPSS Statistics Version 28
Variable
Total
Sepsis Survivors
Sepsis Mortality
P value
Patients (% Male) Age (yr)
65 (49.2%)
33 (51.5%)
32 (46.9%)
0.714
75.2 ± 14.0
73.6 ± 16.8
77.0 ± 10.4
0.337
BMI
29.6 ± 9.5
29.4 ± 9.1
29.7 ± 9.9
0.873
% HTN
68.8%
72.7%
64.5%
0.488
% DM
29.7%
27.3%
32.3%
0.669
Degree Sepsis
2.65 ± 0.57
2.55 ± 0.51
2.75 ± 0.62
0.152
Sepsis (1)
3
0 (0%)
3 (100%)
-
Severe Sepsis (2)
17
15 (88.2%)
2 (11.8%)
-
Septic Shock (3)
45
18 (40%)
27 (60%)
-
CPO (W)
1.10 ± 0.46
1.23 ± 0.48
0.97 ± 0.39
0.018
•
•
•
CPO is a statistically significant predictor of mortality in sepsis based on univariate logistic regression compared to other hemodynamic measurements Accounting for time to event data, the Cox Proportional Hazard regression also finds increased CPO to be protective in sepsis Early echocardiograms can provide insight into prognosis for septic patients
Table 1 Patient characteristics of study. Sepsis severity is defined as 1, sepsis; 2,severe sepsis; 3,septic shock. P values represent Student’s T test between sepsis survivors and sepsis mortality groups. Abbreviations: HTN, hypertension; DM, type 2 diabetes mellitus CPO, cardiac power output; W, watts
Future Direction
Cox Proportional Hazard Regression
• A larger data set is necessary to determine clinically relevant CPO cutoff values • The effect of other sepsis markers such as lactate levels can be explored in a future multivariate analysis
Variable
HR (95% CI)
P value
Age
1.015 (0.98-1.052)
0.399
CPO
0.301 (0.116-0.783)
0.014
HTN
0.790 (0.371-1.684)
0.542
Table 2 Cox Proportional Hazard regression. Multivariate analysis of cardiac power output alongside relevant comorbidities demonstrates a protective effect of increased CPO. Abbreviations: HTN, hypertension; DM, type 2 diabetes mellitus; CPO, cardiac power output; HR, hazard ratio
Univariate Logistic Regression Variable
OR (95% CI)
P value
CPO
0.036 (0.002-0.612)
0.022
SV
1.017 (0.97-1.067)
0.482
CO
1.306 (0.692-2.462)
0.410
Figure 7: Independent CRISPR knockout of CDK4 or CDK6 does not cause dropout in most breast cancer cell lines studied.
Table 3 Univariate Logistic Regression. Univariate analysis comparing different hemodynamic parameters for in-patient mortality for sepsis. Abbreviations: CPO, cardiac power output; SV, stroke volume; CO, cardiac output; OR, odds ratio.
Reference 1. Fincke R, Hochman JS, Lowe AM, et al. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll Cardiol. 2004;44(2):340-348