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Published on: June 12, 2021
Influence of Sepsis on Clinical Outcomes During Mechanical Circulatory Support by Microaxial Flow Pump in Patients
Philip Düsing1, Julia Markgraf1, Baravan Al-Kassou1
1Heart Center, Department of Medicine II, University Hospital Bonn, 53127 Bonn, Germany.
Insights
Sepsis significantly increases mortality risk in patients with cardiogenic shock (CS) treated with mechanical circulatory support (MCS) using a microaxial flow pump. This complication elevates 30-day and 365-day all-cause mortality rates in CS patients following acute myocardial infarction.
Area of Science:
- Cardiology
- Critical Care Medicine
- Infectious Diseases
Background:
- Cardiogenic shock (CS) is a critical condition of low cardiac output, often leading to multisystem organ failure.
- Revascularization was the primary treatment for CS post-acute myocardial infarction (AMI) for decades.
- Mechanical circulatory support (MCS) with microaxial flow pumps shows promise in reducing mortality for STEMI-related CS, but complications like sepsis are noted.
Purpose of the Study:
- To investigate the impact of sepsis on patient outcomes in cardiogenic shock (CS) treated with temporary mechanical circulatory support (MCS).
- To analyze the association between sepsis and mortality rates in patients receiving microaxial flow pump support for CS.
Main Methods:
- Retrospective cohort study of 38 patients with CS receiving a microaxial flow pump between 2014 and 2017.
- Sepsis defined as infection with an increase in Sequential Organ Failure Assessment (SOFA) score of ≥2 points.
- Clinical outcomes assessed included all-cause mortality at 30 and 365 days, and renal function changes.
Main Results:
- The 30-day all-cause mortality was substantially higher in the sepsis group (53.9%) compared to the no-sepsis group (8.3%, p=0.014).
- Mortality rates at 365 days also showed a significant difference, with higher rates in the sepsis group (65.4%) versus the no-sepsis group (16.7%, p=0.008).
- Renal function changes were also analyzed, though specific findings are not detailed in the abstract.
Conclusions:
- Sepsis is a significant risk factor for increased all-cause mortality in patients with cardiogenic shock (CS) treated with microaxial flow pump MCS.
- The findings highlight the critical need to monitor and manage sepsis in CS patients undergoing mechanical circulatory support.
- Early identification and treatment of sepsis may be crucial for improving survival rates in this vulnerable patient population.
Abstract:
Background: Cardiogenic shock (CS) is characterized as a state of low cardiac output that is frequently associated with multisystem organ failure. For over two decades, revascularization of the culprit lesion remained the only interventional treatment option to improve outcomes in CS following acute myocardial infarction. However, recently published data provide evidence that the use of a microaxial flow pump for mechanical circulatory support (MCS) in STEMI-related cardiogenic shock significantly reduced mortality after 180 days. Increased rates of complications such as sepsis were observed under MCS. The present study aimed to investigate the influence of sepsis on prognoses in patients with CS receiving temporary MCS with a microaxial flow pump. Methods and Results: This retrospective cohort study included 38 patients who received a microaxial flow pump for CS between 2014 and 2017. All patients were analyzed for the presence of sepsis, defined as infection and an increase in the Sequential Organ Failure Assessment (SOFA) score of ≥2 points. Analyzed clinical outcomes included all-cause mortality after 30 and 365 days and changes in renal function. A total of 38 patients were included in the final analysis. The 30-day all-cause mortality was significantly higher in the sepsis group than in the no-sepsis group (53.9% vs. 8.3%, p = 0.014). The findings were consistent for mortality at 365 days (65.4% vs. 16.7%, p = 0.008). Conclusions: These results indicate that sepsis significantly increases the risk of all-cause mortality at 30 and 365 days among patients with CS following AMI and receiving MCS via a microaxial flow pump.