Cardiac Performance by Echocardiography, Cardiovascular Biomarker, Kidney Function, and Venous Oxygen Saturation as Mortality Predictors of Septic Shock

Pudjo Rahasto, BUdhi Setianto, Ina S Timan, Suhendro Suhendro, Lugyanti Sukrisman, Renan Sukamawan, Mondastri K Sudaryo, Peter Kabo


Background: cardiac function in patients with septic shock at the cellular level can be assessed by measuring troponin I and NT Pro BNP levels. Venous oxygen saturation is measured to evaluate oxygen delivery and uptake by organ tissue. Our study may provide greater knowledge and understanding on pathophysiology of cardiovascular disorder in patients with septic shock. This study aimed to evaluate the roles of echocardiography, cardiovascular biomarkers, venous oxygen saturation and renal function as predictors of mortality rate in patients with septic shock. Methods: this is a prospective cohort study in patients with infections, hypotension (MAP < 65 mmHg) and serum lactate level of > 2 mmol/L. On the first and fifth days, septic patients underwent echocardiography and blood tests. Statistical analysis used in our study included t-test or Mann-Whitney test for numeric data and chi-square test for nominal data of two-variable groups; while for multivariate analysis, we used Cox Regression model. Results: on 10 days of observation, we found 64 (58%) patients died and 47 (42%) patients survived. The mean age of patients was 48 (SD 18) years. Patients with abnormal left ventricular ejection fraction (LVEF) had 1.6 times greater risk of mortality than those with normal LVEF (RR 1.6; p = 0.034). Patients with abnormal troponin I level showed higher risk of mortality as many as 1.6 times (RR: 1.6; p = 0.004). Patients with impaired renal function had 1.5 times risk of mortality (RR 1.5; p = 0.024). Patients with abnormal troponin I level and/or impaired renal function showed increased mortality risk; however, those with normal troponin I level and impaired renal function also showed increased mortality risk. Multivariate analysis revealed that left ventricular ejection fraction and troponin I level may serve as predictors of mortality in patients with septic shock. (HR 1.99; 95% CI: 1.099  ̶  3.956 ; p = 0.047 and HR: 1.83 ; 95%CI: 1.049  ̶ 3,215 ; p = 0.043). Conclusion: left ventricular ejection fraction and biomarkers such as troponin I level are predictors of mortality in septic shock patients.


echocardiography; death; NT Pro BNP; septic shock; troponin I


Braunwald E, Sonnenblick EH, Ross J. Mechanism of cardiac contraction and relaxation. In: Braunwald, ed. Heart disease: A textbook of cardiovascular medicine. Philadelphia: WB Saunders Co; 2008. p. 351 ̶ 87.

Singer M, Deutsschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801 ̶ 10.

O’Connell JB, Costanzo-Nordin MR, Subramaniah R, Robinsosn JA, Wallis DE, Scanlon PJ, Gunnar RM. Peripartum cardiomyopathy: Clinical, hemodynamic, histologic and prognostic characteristics. JACC. 1996; 8:52 ̶ 6.

Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiograpy. J Am Soc Echocardiogr. 1989;2:358 ̶ 67.

Rudski LG, Lai WW, Asfilalo J, et al. Guidelines and standards, guidelines for the echocardiographic assessment of the right heart in adults: a report from the american society of echocardiography. J Am Soc Echocardiogr. 2010;23:685 ̶ 713.

Nagueh SF, Appleton CP, Gillebert TC, et al. Guidelines and standards; recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107 ̶ 33.

Nagueh SF, Smiseth OA, Appleton CP, et al. ASE/EACVI guidelines and standards, recommendation for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and European Association of Cardiovascular Imaging. J Am SocEchocardiogr. 2016;29:277 ̶ 314.

Landesberg G, Gilon D, Meroz Y, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J. 2011;351:1 ̶ 9.

Palazzuoli A, Gallota M, Quatrini I, NutiR. Natriuretic peptides (bnp and nt-probnp): measurement and relevance an heart failure. Vasc Health Risk Manag. 2010;6:411 ̶ 8.

Daniels LB, Maisel A. Natriuretic peptides. J Am Coll.Cardiol. 2007;50:2357 ̶ 69.

Sinto R, Suwanto S. Parameter akhir resusitasi makrosirkulasi dan mikrosirkulasi pada sepsis berat dan renjatan septik. J Peny Dalam Indon. 2014;1:68 ̶ 75.

Sturgess DJ, Marwick TH, Joyce C, et al. Prediction of hospital outcome in septic sock: a prospective comparison of tissue doppler and cardiac biomarker. Critical Care. 2010;14:R44.

Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006;48:1 ̶ 11.

Kociol RD, Pang PS, Gheorghiade M, Fonarow GC, O’Connor CM, Felker GM. Troponin elevation in heart failure: prevalence, mechanisms, and clinical implications. J Am Coll Cardiol. 2010;56:1071 ̶ 8.

Ammann P, Maggiorini M, Bertel O, et al. Troponin as a risk factor for mortality in crically ill patients without acute coronary syndromes. J Am Coll Cardiol. 2003;41:204 ̶ 9.

Rudiger A. Singer M. Mechanisms of sepsis-induce cardiac dysfunction. Crit Care Med. 2007;35:1599 ̶ 608.

Ryding AD, Kumar S, Worthington AM, Burgess D. Prognostic value of Natriuretic peptide in Noncardiac surgery, a meta-analysis. Anesthesiology. 2009;111:311 ̶ 9.

Costello-Boerrigter LC, Boerrigter G, Redfield MM, et al. Amino-terminal pro-b-type natriuretic peptide and b-type natriuretic peptide in the general community. J Am Coll Cardiol. 2006;47:345 ̶ 53.

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