Novel Echocardiogram Analysis of Cardiac Dysfunction is Associated with Mortality in Pediatric Sepsis

Daniel T Cater; Brett A Meyers; Shailee Mitra; Sayantan Bhattacharya; Roberto F Machado; Ryan Serrano; Courtney M Rowan; Benjamin Gaston; Pavlos Vlachos

doi:10.1097/SHK.0000000000002359

Novel Echocardiogram Analysis of Cardiac Dysfunction is Associated with Mortality in Pediatric Sepsis

Shock. 2024 Mar 25. doi: 10.1097/SHK.0000000000002359. Online ahead of print.

Authors

Daniel T Cater¹, Brett A Meyers², Shailee Mitra², Sayantan Bhattacharya², Roberto F Machado³, Ryan Serrano⁴, Courtney M Rowan¹, Benjamin Gaston⁵, Pavlos Vlachos²

Affiliations

¹ Division of Critical Care, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis IN, USA.
² School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA.
³ Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
⁴ Division of Pediatric Cardiology, Loma Linda University Children's Hospital and Medical Center, Loma Linda, CA, USA.
⁵ Riley Hospital for Children and the Herman B. Wells Center for Pediatric Research, Indianapolis, IN, USA.

PMID: 38661156
DOI: 10.1097/SHK.0000000000002359

Abstract

Objectives: The objective of our study was to semi-automatically generate echocardiogram indices in pediatric sepsis using novel algorithms and determine which indices were associated with mortality. We hypothesized that strain and diastolic indices would be most associated with mortality.

Design: Retrospective cohort study of children with sepsis from 2017-2022. Survivors and non-survivors were compared for echocardiogram indices. Multivariate Cox proportional hazard models were constructed for our primary outcome of in-hospital mortality. Linear regression was performed for secondary outcomes, which included multiple composite 28-day outcomes.

Results: Of the 54 patients in the study 9 (17%) died. Multiple echocardiogram indices of both right (RV) and left ventricles (LV) were associated with in-hospital mortality [RV GLS adjusted hazard ratio (aHR): 1.16 (1.03-1.29), p-value 0.011; RV global longitudinal early diastolic strain rate (GLSre) aHR:0.24 (0.07 to 0.75), p-value 0.014; LV GLSre aHR: 0.33 (0.11-0.97), p-value 0.044]. Impairment in GLS was associated with fewer ventilator-free days [RV GLS β-coefficient: -0.47 (-0.84 to -0.10), p-value 0.013; LV GLS β-coefficient -0.62 (-1.07 to -0.17), p-value 0.008], organ-support free days [RV GLS β-coefficient: -0.49 (-0.87 to -0.11), p-value 0.013; LV GLS β-coefficient: -0.64 (-1.10 to -0.17), p-value 0.008], and days free from ICU [RV GLS β-coefficient: -0.42 (-0.79 to -0.05), p-value 0.026; LV GLS β-coefficient:-0.58 (-1.03 to -0.13), p-value 0.012]. Systolic indices were not associated with mortality in this cohort.

Conclusions: Our study demonstrates the feasibility of obtaining echocardiogram indices in a semi-automatic method using our algorithms. We showed that abnormal strain is associated with worse outcomes in a cohort of children with sepsis.