P0576LEFT VENTRICULAR FUNCTION ON TISSUE PERFUSION AND RENAL OUTCOMES IN CRITICALLY ILL PATIENTS WITH SEPSIS

• Published in: Nephrology, dialysis, transplantation Vol. 35; no. Supplement_3
• Main Authors: Shin, Jungho, Hwang, Jin Ho, Kim, Su-Hyun
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.06.2020
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfaa142.P0576

Abstract Background and Aims Left ventricular (LV) dysfunction has been regarded as a predictor of mortality in patients with sepsis. However, it remains uncertain whether LV dysfunction deteriorates multiple organ failure by impairing tissue perfusion or it has an independent impact. In this study, we investigated the association between LV dysfunction and tissue perfusion, and their impacts on renal outcomes in critically ill patients with sepsis. Method We retrospectively reviewed a total of 162 adult patients with sepsis who met the Sepsis-3 definition. Subjects included 83 (51.2%) with normal LV function, 39 (24.1%) with diastolic dysfunction defined as the septal E/e’ ratio >15 among patients with ejection fraction ≥50% and 40 (24.7%) with systolic dysfunction defined as an ejection fraction <50%. Tissue perfusion was assessed by the levels of blood lactate. Results The initial and 24h levels of lactate, and lactate clearance did not differ regardless of the presence of LV dysfunction (P=0.861, 0.907 and 0.363). The incidence rate of acute kidney injury (AKI) among the patients with initial lactate <2 mmol/L was higher in those with LV dysfunction (P=0.044), conversely, the incidence rate was comparable in the patients with initial lactate ≥2 mmol/L (P=0.797). Risks of AKI and renal replacement therapy implementation increased if subjects had blood lactate levels ≥2 mmol/L (P=0.009 and 0.080), however, the impact of LV dysfunction on these outcomes depended on previous chronic kidney disease and lactate levels (diastolic dysfunction: P=0.449 and 0.663; systolic dysfunction: P=0.062 and 0.161). However, renal replacement therapy-free days were shorter in those with LV dysfunction, independent of previous chronic kidney disease (P=0.003). Renal function at discharge was not related to the lactate levels and LV function in this study (P=0.685 and 0.089) Conclusion LV dysfunction might not influence tissue perfusion in patients with sepsis, on the other hand, it could lengthen the duration of renal replacement therapy. Therapeutic options for preserving microcirculation should be warranted in patients with sepsis, in addition to individualized therapies tailored their LV function.