To Assess the Echocardiogram Parameters in Predicting the Outcome in Patients with Sepsis/Septic Shock

INTRODUCTION: Sepsis presents a significant global health burden, affecting an estimated 47 to 50 million individuals annually, with mortality rates reaching 11 million per year, accounting for 20% of global deaths.(1) Septic cardiomyopathy, occurring in approximately 44% of cases, remains a topic of ongoing research due to conflicting findings regarding its impact on patient survival.(1) Our study aims to predict the role of TAPSE and MAPSE (echocardiogram parameters) in predicting mortality in patients with sepsis and septic shock. OBJECTIVES: Our primary objective focuses on evaluating the prognostic capability of Tricuspid Annular Plane Systolic Excursion (TAPSE) and Mitral Annular Plane Systolic Excursion (MAPSE) in predicting 30-day mortality among sub-group of critically ill sepsis/septic shock patients. Secondary objectives include assessing the association of TAPSE and MAPSE with length of ICU stay, cumulative fluid balance, difference in MAPSE and TAPSE value after resuscitation, ventilator-free days, delta SOFA score, and 3-month mortality. MATERIALS & METHODS: This prospective observational study, conducted at a tertiary care hospital, includes patients over 18 years presenting within 48 hours of sepsis symptoms or developing symptoms during hospitalization, adhering to Sepsis-3 criteria. Patients with poor echocardiogram views, pregnancy, pre-existing cardiac dysfunction, known Cor pulmonale, or COPD were excluded from the study. Patients admitted to the ICU were initially screened and those meeting inclusion criteria were included in the study. Patient's demographic details, cardiac biomarkers, SOFA score and APACHEII score were noted. Echocardiographic assessments (TAPSE/MAPSE) were done upon admission, with daily recordings until ICU discharge. All patients were followed for 3 months and at the end of the study period patients were divided into survivors and non survivors. AUC- ROC was done to analyze the relationship between TAPSE/MAPSE values with 30-day and 90-day mortality. The admission SOFA score, delta SOFA, number of inotropes, ventilator-free days, and 3 – 3-month mortality were also analyzed and compared with the TAPSE/MAPSE value. RESULTS: In our study, a total of 547 patients were screened, and after screening 90 patients were included in the study and followed up. We used Youden's index to get the optimal cutoff values. MAPSE demonstrated sensitivity (69.35%) and specificity (75.00%) and ROC area of 0.7365 (CI 95%), while TAPSE showed sensitivity (95.16%) and specificity (32.14%). sensitivity and ROC of 0.6892 (CI 95). Moreover, MAPSE and TAPSE values strongly correlate with SOFA scores, APACHE II scores, cardiac biomarkers, and inotropic requirements, suggesting their potential as valuable prognostic markers. Also, our analysis showed a significant improvement in MAPSE and TAPSE values after fluid resuscitation. DISCUSSION: Our findings indicate both MAPSE and TAPSE possess promising predictive correlations with patient outcomes in sepsis/septic shock scenarios. These parameters exhibit high sensitivity and specificity in predicting 30-day mortality. Jun Dong et all(2) in their retrospective observational study analyzed the outcome of TAPSE with the mortality of patients presenting with sepsis and found that the ROC curves of TAPSE emerged as a significant and moderate predictor for 90-day mortality with area under curve (AUC) = 0.69, 95% CI = 0.565-0.814 with a sensitivity of 80% and specificity of 58% with an optimal cut-off of 2.1cm. Havaldar AA et all(3) in their observational study compared the various left ventricular echocardiogram parameters, out of which MAPSE had an AUC ROC of 0.822 compared to E/e’ and left ventricular systolic function. Compared to the above studies, our study showed that a cut-off of MAPSE and TAPSE VALUE (13mm and 15mm, respectively) had a better sensitivity and specificity in predicting the outcome of patients. The cut-off in our study was lower for TAPSE compared to other studies and higher for MAPSE when compared to previous studies. CONCLUSION: Based on the findings, we conclude that MAPSE has a strong predictive ability, while TAPSE has moderate predictive ability, for 30-day outcomes in patients with sepsis or septic shock. These findings highlight the potential of integrating MAPSE and TAPSE into early risk stratification and management strategies for septic patients.