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Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis

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Abstract

Purpose

Mechanisms of circulatory failure are complex and frequently intricate in septic shock. Better characterization could help to optimize hemodynamic support.

Methods

Two published prospective databases from 12 different ICUs including echocardiographic monitoring performed by a transesophageal route at the initial phase of septic shock were merged for post hoc analysis. Hierarchical clustering in a principal components approach was used to define cardiovascular phenotypes using clinical and echocardiographic parameters. Missing data were imputed.

Findings

A total of 360 patients (median age 64 [55; 74]) were included in the analysis. Five different clusters were defined: patients well resuscitated (cluster 1, n = 61, 16.9%) without left ventricular (LV) systolic dysfunction, right ventricular (RV) failure or fluid responsiveness, patients with LV systolic dysfunction (cluster 2, n = 64, 17.7%), patients with hyperkinetic profile (cluster 3, n = 84, 23.3%), patients with RV failure (cluster 4, n = 81, 22.5%) and patients with persistent hypovolemia (cluster 5, n = 70, 19.4%). Day 7 mortality was 9.8%, 32.8%, 8.3%, 27.2%, and 23.2%, while ICU mortality was 21.3%, 50.0%, 23.8%, 42.0%, and 38.6% in clusters 1, 2, 3, 4, and 5, respectively (p < 0.001 for both).

Conclusion

Our clustering approach on a large population of septic shock patients, based on clinical and echocardiographic parameters, was able to characterize five different cardiovascular phenotypes. How this could help physicians to optimize hemodynamic support should be evaluated in the future.

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Acknowledgements

The authors thank Mr. David Marsh for his English editing and Dr. Ana Catalina Hernandez Padilla for her help in the data management.

Funding

The Hemosepsis study was financially supported by the Programme de Recherche Clinique Inter-régional (academic financial support provided by the French Ministry of Health). The Hemopred study was financially supported by the CIC-P 1435, CHU Limoges.

Author information

Authors and Affiliations

  1. Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France

    Guillaume Geri, Alix Aubry, Cyril Charron, Xavier Repessé & Antoine Vieillard-Baron

  2. UFR des Sciences de la Santé Simone Veil, Université Versailles Saint Quentin, Versailles, France

    Guillaume Geri, Alix Aubry & Antoine Vieillard-Baron

  3. INSERM UMR1018, Team Kidney and Heart, CESP, Villejuif, France

    Guillaume Geri & Antoine Vieillard-Baron

  4. Medical-Surgical Intensive Care Unit, Limoges University Hospital, Limoges, France

    Philippe Vignon & Anne-Laure Fedou

  5. Faculty of Medicine, University of Limoges, Limoges, France

    Philippe Vignon

  6. INSERM CIC 1435, Limoges University Hospital, Limoges, France

    Philippe Vignon

  7. Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France

    Stein Silva

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  1. Guillaume Geri
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  2. Philippe Vignon
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  7. Xavier Repessé
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  8. Antoine Vieillard-Baron
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Contributions

GG, PV, AA and AVB designed the study and drafted the manuscript. PV, AA, ALF, CC, SS, XR and AVB collected the data. GG conducted the statistical analysis. AA, ALF, CC, SS and XR carefully revised the manuscript.

Corresponding author

Correspondence to Antoine Vieillard-Baron.

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Conflicts of interest

GG, PV, AU, ALF, CC, SS, XR declared no conflict of interest. AVB has received grant from GSK for conducting clinical research and is a member of the scientific advisory board.

Ethical approval

Both cohorts (Hemosepsis and Hemopred) received Limoges ethics committee approval.

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Geri, G., Vignon, P., Aubry, A. et al. Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis. Intensive Care Med 45, 657–667 (2019). https://doi.org/10.1007/s00134-019-05596-z

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  • DOI: https://doi.org/10.1007/s00134-019-05596-z

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