Related Experiment Video
Updated: May 11, 2026
Histological Quantification of Chronic Myocardial Infarct in Rats
Published on: December 11, 2016
Comparing cardiac index and left ventricular ejection fraction in ICU patients with sepsis
Minesh Chotalia1, Muzzammil Ali2, Ravi Chotalia3
1Birmingham Acute Care Research Group, University of Birmingham, Birmingham, UK; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital, Birmingham, UK.
Insights
Cardiac index (CI) and left ventricular ejection fraction (LVEF) are key hemodynamic parameters in sepsis. Combining CI and LVEF offers improved prognostic accuracy for 90-day mortality in intensive care unit patients with sepsis.
Area of Science:
- Critical Care Medicine
- Cardiology
- Hemodynamics
Background:
- Optimal cardiovascular function assessment in sepsis remains unclear.
- Investigating echocardiography-derived cardiac index (CI) versus left ventricular ejection fraction (LVEF) for hemodynamic monitoring and prognosis in sepsis.
Purpose of the Study:
- To compare the prognostic value of cardiac index (CI) and left ventricular ejection fraction (LVEF) in intensive care unit (ICU) patients with sepsis.
- To determine if CI offers superior hemodynamic monitoring compared to LVEF.
Main Methods:
- Retrospective cohort study of 1731 ICU patients with sepsis.
- Transthoracic echocardiogram (TTE) assessed within seven days of sepsis onset.
- Correlation analysis (Spearman) and multivariable logistic regression for mortality prediction.
Main Results:
- Moderate correlation (r=0.51) between CI and LVEF; one-third of patients had discordant classifications.
- Both low/high CI and low/high LVEF independently associated with increased 90-day mortality.
- Combining CI and LVEF phenotypes significantly improved prognostic accuracy.
Conclusions:
- CI and LVEF are non-equivalent hemodynamic parameters in sepsis, especially when abnormal.
- While both markers correlate with mortality, their combined use enhances prognostic capability.
- Utilizing both CI and LVEF provides a more comprehensive assessment of cardiovascular function and patient outcomes in sepsis.
Background:
The optimal parameter to assess cardiovascular function in sepsis is currently unknown. We investigated whether echocardiography-derived cardiac index offers superior haemodynamic monitoring and prognostic value compared to left ventricular ejection fraction (LVEF) in ICU patients with sepsis.
Methods:
We conducted a retrospective, single-centre cohort study in ICU patients with sepsis admitted between April 2016 and December 2021 that received a transthoracic echocardiogram (TTE) within seven days of sepsis onset. Correlation between CI and LVEF was assessed using the Spearman rank test. The 90-day mortality rates of normal, low and high CI and LVEF subgroups were compared. Multivariable logistic regression analysis was performed to determine the association of CI and LVEF phenotypes with mortality.
Results:
1731 patients were included and were aged 62 years (IQR 47-72), with 21% (n = 367) having septic shock. Ninety-day mortality was 32.5% (n = 561). Although CI and LVEF demonstrated moderate correlation (r = 0.51 (0.47-0.54), one-third of patients in a given CI subgroup were classified into a discordant LVEF subgroup. The 90-day mortality rates of low and high CI (54%, 54%) and low and high LVEF subgroups (43%, 59%) were broadly comparable and were higher than their normal CI (20%) and LVEF (23%) counterparts respectively. After regression analysis, low and high CI independently associated with mortality (OR 2.6 (1.8-3.7; p < 0.001), (OR 3.4 (2.7-4.4; p < 0.001), as did low and high LVEF subgroups (OR 1.6 (1.2-2.3; p = 0.004), OR 3.2 (2.4-4.3; p < 0.001). Stratifying CI subgroups into low, normal and high LVEF (and vice-versa) was associated with significantly different mortality rates.
Conclusions:
Although CI and LVEF were modestly correlated, this association weakened when either parameter was abnormal, highlighting their non-equivalence as haemodynamic parameters. While both markers exhibited comparable associations with mortality, their combination substantially improved prognostic accuracy.
