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Published on: October 14, 2016
Prevalence and Outcome of Sepsis-induced Myocardial Dysfunction in Children with 'Sepsis' 'With' and 'Without
Aditi Jain1, Jhuma Sankar2, Anubhuti Anubhuti3
1Department of Pediatrics, PGIMER and Dr RML Hospital, New Delhi, Delhi 110001, India.
Insights
Sepsis-induced myocardial dysfunction (SIMD) is common in children with septic shock, often presenting as diastolic dysfunction. While it may increase inotrope needs, SIMD is typically reversible within three months.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Infectious Diseases
Background:
- Sepsis-induced myocardial dysfunction (SIMD) is a serious complication in children.
- Understanding its prevalence and effects in pediatric septic shock is crucial for timely intervention.
Purpose of the Study:
- To determine the prevalence and effects of SIMD in children experiencing septic shock.
- To assess the correlation between SIMD and clinical outcomes, including inotrope requirements.
Main Methods:
- Echocardiography and cardiac troponin-I (cTnI) levels were measured in children with septic shock and sepsis within 3 hours of enrollment.
- SIMD was diagnosed based on echocardiographic evidence of systolic or diastolic dysfunction.
Main Results:
- SIMD prevalence was 71% in septic shock and 23% in sepsis, with diastolic dysfunction being more common.
- Children with SIMD required more inotropes (81% vs. 44%) and cTnI showed low sensitivity and specificity for detecting SIMD.
- Most cases of SIMD resolved within 3 months, indicating reversibility.
Conclusions:
- SIMD, particularly diastolic dysfunction, is highly prevalent in pediatric septic shock and linked to increased inotrope use.
- Asymptomatic SIMD may be present in sepsis patients, and cTnI is not a reliable marker for its severity.
- The majority of pediatric SIMD cases are reversible, suggesting a positive long-term prognosis.
Objective:
To estimate the prevalence and effects of sepsis-induced myocardial dysfunction (SIMD) in children with septic shock.
Methodology:
Enrolled children with septic shock (n = 31) and sepsis (n = 30) underwent echocardiography and cardiac troponin-I (cTnI) estimation within first 3 h. SIMD was defined as presence of systolic/diastolic dysfunction by echocardiography.
Results:
The prevalence of SIMD was 71% in 'septic shock' and 23% in 'sepsis'. Diastolic dysfunction (45.2%) was more prevalent than systolic dysfunction (32.3%). Children with SIMD had higher requirement of inotropes [81 vs. 44%; adjusted odds ratio: 1.41 (1.04-1.92)] in first 48 h. cTnI had low sensitivity (62.5%) and specificity (55.1%) for detecting SIMD. On follow-up at 3 months, there was no residual dysfunction in the majority (71.3%).
Conclusion:
SIMD, especially diastolic dysfunction, is common in septic shock and may increase inotrope requirement. It is reversible in majority. Sepsis patients may have asymptomatic underlying SIMD. cTnI does not correlate with the degree of SIMD.
