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ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 177-183

Relation of left ventricular function and serum interleukin level to mortality in septic patients


1 Department of Critical Care Medicine, Cairo University, Cairo, Egypt
2 Critical Care Medicine, Manchester Royal Infirmary, University of Manchester, United Kingdom

Correspondence Address:
Abdou M Azab
Critical Care Departement, Kasr Elini Old Medical School, Postal code 11562
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_79_16

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Introduction Left ventricular systolic dysfunction and elevated serum interleukins (ILs) are common in septic patients. However, whether left ventricular diastolic dysfunction is related to mortality in septic patients is a matter of debate. Aim The aim of the study was to assess the effect of myocardial systolic and diastolic functions on mortality in cases of sepsis and to predict an inflammatory marker that could be clearly linked to mortality in sepsis. Patients and methods Twenty patients were prospectively studied, with measurement of the following on admission and on day 7: left ventricular end-diastolic volume, left ventricular end-systolic volume, left ventricular ejection fraction% (echocardiography), mitral annulus S-velocity, Ed/t, and serum levels of ILs (IL-1α, IL-1β, IL-6, and IL-10). Mortality on day 28 was the study endpoint. Results Twenty patients with sepsis and septic shock were studied (45% were male and 55% were female; mean age 52±17 years). The patients were divided into group I (survivors, 55%) and group II (nonsurvivors, 45%). Regarding echocardiography there was no significant difference between the two groups in end-diastolic volume, end-systolic volume, or ejection fraction% (112.3±51 vs. 94.5±30, 43.8±30 vs. 29.4±22, and 61.5±12 vs.71.2±11; P=0.4, 0.1, and 0.08, respectively) on admission or on day 7 (114.6±21 vs. 99.8±65, 43.8±30 vs. 29.4±22, 61.7±12 vs. 59.6±17; P=0.1, 0.2, and 0.7, respectively), whereas Ed/t data on admission showed statistically significant short Ed/t in group II (103.5±28) compared with group I (127.2±25) (P=0.04). However, on day 7 the difference was not significant (115.3±41 vs. 119±48, P=0.8). The mitral annulus S-velocity did not show significant difference either on admission (10.7±5 vs. 9.9±2, P=0.9) or on day 7 (8.6±4 vs. 10.7±4, P=0.1). Regarding the levels of ILs, there was no difference between group I and group II in terms of admission IL-1α (33.7±48 vs. 27.1±21, P=0.7), IL-1β (74±55 vs. 54.5±32, P=0.7), IL-6 (235.1±357 vs. 234.2±355, P=0.9), or IL-10 (110.7±121 vs. 135.3±241, P=0.9) or in terms of day 7 IL-1α (41.6±76 vs. 208.2±410, P=0.8), IL-1β (154.1±255 vs. 39.3±15, P=0.06), or IL-10 (87.2±230 vs. 189.6±335, P=0.9). However, on day 7 IL-6 showed a significantly high level in group II (294.8±385) versus group I (68.9±110) (P=0.05). Conclusion Systolic function did not predict prognosis. However, diastolic dysfunction in the form of Ed/t predicted poor prognosis. The higher IL-6 level on day 7 was a good predictor of mortality.


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