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Kidney Week

Abstract: FR-PO028

Diastolic and Systolic Dysfunction on Renal Outcomes in Critically Ill Patients with Sepsis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Moon, Ji in, Chungang university, Seoul, Korea (the Republic of)
  • Jung, Jihoon, Chung-Ang university hospital, Seoul, Korea (the Republic of)
  • Hwang, Jin Ho, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
  • Kim, Su Hyun, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
  • Shin, Jungho, Chung-Ang University College of Medicine, Seoul, Korea (the Republic of)
Background

Diastolic and systolic dysfunction have been regarded as predictors of mortality in patients with severe sepsis and septic shock. Myocardial dysfunction may contribute to hemodynamic instability and may result in organ failure, but their impacts on renal outcomes remain uncertain. In this study, we investigated the impacts of diastolic and systolic dysfunction on renal outcomes in critically ill patients with sepsis.

Methods

We retrospectively reviewed a total of 164 adult patients with sepsis who met the Sepsis-3 definition. Left ventricular (LV) function was assessed using echocardiography within 5 days from the intensive care unit admission. Systolic dysfunction was defined as an ejection fraction <50%, and diastolic dysfunction was defined as the septal E/e’ ratio >15 among patients with ejection fraction ≥50%. Acute kidney injury (AKI) was defined using the KDIGO guideline.

Results

There were 86 (52.4%) with normal LV function, 37 (22.6%) with diastolic dysfunction and 41 (25.0%) with systolic dysfunction. The incidence rate of AKI was 68.6%, 83.8% and 87.8% in the respective groups (P=0.029). Patients with diastolic and systolic dysfunction had more highly required renal replacement therapy than those with normal LV function, and these results persisted after the adjustment for age, sex and the sequential organ failure assessment (SOFA) score (OR for diastolic dysfunction 3.6, 95% CI 1.0–12.3, P=0.045 and OR for systolic dysfunction 3.1, 95% CI 1.0–9.4, P=0.045). Moreover, diastolic dysfunction predicted 28-day mortality, independent of age, sex and the SOFA score (HR 3.3, 95% CI 1.1–9.9, P=0.033), but systolic dysfunction did not (P=0.094 in multivariate analysis).

Conclusion

Both diastolic and systolic dysfunction could predict the AKI occurrence and renal replacement therapy need in critically ill patients with sepsis. More studies are needed to investigate individualized approaches according to LV function in this disease population.