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The effect of myocardial dysfunction on mortality in children with septic shock: a prospective observational study

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Abstract

Pediatric septic shock is defined as progressive multi-organ dysfunction and cardiovascular dysfunction accompanying sepsis. Studies showing myocardial dysfunction associated with pediatric septic shock are very limited. The aim of this study was to evaluate the relationship between myocardial functions calculated by echocardiography, disease severity, and clinical outcomes in children with septic shock. This observational prospective study was conducted in a pediatric intensive care at a university-affiliated tertiary hospital. The patients diagnosed with septic shock between January 2021 and February 2022 were included in the study. The study was conducted with 56 patients. The rate of myocardial dysfunction (systolic and/or diastolic dysfunction) was 50%. Of these, 39.3% (n = 22) had systolic dysfunction, 17.9% (n = 10) had diastolic dysfunction, and 8.9% (n = 5) had both systolic and diastolic dysfunction. PRISM III score (p = 0.004), VIS (p < 0.001), lactate (p = 0.002), CK-MB (p = 0.023), troponin (p = 0.038), EF (p = 0.004) EF z-score (p = 0.003), MAPSE z-score (p = 0.049), TAPSE (p = 0.010), TAPSE z-score (p = 0.003), and mitral valve E/e ´z-score (p = 0.028) were statistically significant difference with mortality. No significant difference was found for mortality with MAPSE (p = 0.090), mitral valve E/A (p = 0.624), and mitral valve E/A z-score (p = 0.327). EF z-score was found to be associated with 30-day mortality (OR = 0,681, 95% CI 0,480 to 0.991, p = 0,045). We found the TAPSE z-score to be the most significant parameter with 30-day mortality (OR = 0,690, 95% CI 0,489 to 0.998, p = 0,032).

  Conclusion: We found left ventricular dysfunction associated factor with mortality. TAPSE showing right ventricular dysfunction was found to be the independent risk factor most associated with mortality.

What is Known:

• Studies showing myocardial dysfunction associated with pediatric septic shock are limited.

• Little is known about the use of echocardiography in pediatric septic shock, and there are no specific guidelines for treatment and follow-up in pediatric patients.

What is New:

• Characteristics, echocardiographic measurements, and outcomes were comprehensively assessed in children with septic shock.

• As a result of our analysis, we found that TAPSE, which is easily measured at the bedside, is the most critical parameter in relation to mortality.

• We offer recommendations for its use in the follow-up of children with septic shock.

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Data availability

The data that support the findings of this study are available on request from the corresponding author (E. S.). The data are not publicly available due to privacy restrictions.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Dr. Behcet Uz Children’s Hospital, University of Health Sciences, Izmir, Turkey

    Ekin Soydan, Gokhan Ceylan, Sevgi Topal, Mustafa Colak, Pınar Seven, Ozlem Sarac Sandal, Gulhan Atakul, Utku Karaarslan & Hasan Agın

  2. Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, University of Health Sciences, Izmir, Turkey

    Mehmet Murat, Ceren Karahan, Ahmet Gonullu & Yigit Aksoy

  3. Department of Pediatric Emergency, Dr. Behcet Uz Children’s Hospital, University of Health Sciences, Izmir, Turkey

    Ceren Karahan, Ahmet Gonullu & Yigit Aksoy

  4. Pediatric Intensive Care Unit, Dr. Behcet Uz Children’s Diseases and Surgery Training and Research Hospital, University of Health Sciences, Izmir, Turkey

    Hasan Agın

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  1. Ekin Soydan
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Contributions

E.S., U.K., and H.A. wrote the main manuscript. P.S., O.S., and G.A. prepared tables. E.S., C.K., and M.M. made conception or design of the work. C.K., A.G.,Y.A., and GC performed the measurements. S.T., and M.C. analysed the data. Final approval of the version to be published was done by E.S., U.K., and H.A.. All authors reviewed the manuscript.

Corresponding author

Correspondence to Ekin Soydan.

Ethics declarations

Ethical approval

The study was conducted by the ethical standards stated in the “Declaration of Helsinki.” The local ethics committee approved the study (protocol number: 2021/571).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Peter de Winter

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Soydan, E., Murat, M., Karahan, C. et al. The effect of myocardial dysfunction on mortality in children with septic shock: a prospective observational study. Eur J Pediatr 182, 4759–4766 (2023). https://doi.org/10.1007/s00431-023-05236-1

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  • DOI: https://doi.org/10.1007/s00431-023-05236-1

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