Myocardial Dysfunction Is Independently Associated With Mortality in Pediatric Septic Shock

Area of Science:

• Pediatric Cardiology
• Critical Care Medicine
• Echocardiography

Background:

• Circulatory dysfunction is a known mortality factor in pediatric septic shock.
• The specific contribution of myocardial dysfunction to mortality, independent of overall illness severity, remains unclear.

Purpose of the Study:

• To determine if sepsis-associated myocardial dysfunction, defined by echocardiographic parameters, independently predicts mortality in pediatric septic shock.
• To adjust for illness severity using the Pediatric Sepsis Biomarker Risk Model II.

Main Methods:

• Retrospective, observational study of children under 18 admitted to a quaternary-care PICU.
• Echocardiograms were analyzed for left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) within 48 hours of septic shock diagnosis.
• Multivariable logistic regression adjusted for baseline mortality risk.

Main Results:

• Low LVEF (<45%) was present in 18% of patients and independently associated with mortality (OR 4.4).
• Low GLS (> -2 z-score) was present in 36% of patients and independently associated with mortality (OR 4.6).
• LVEF as a continuous variable (<65%) was also associated with mortality (OR 0.96).

Conclusions:

• Sepsis-associated myocardial dysfunction, identified by low LVEF or GLS, is an independent predictor of mortality in pediatric septic shock.
• These findings highlight the importance of assessing cardiac function in critically ill children with sepsis.