PMID- 37885490
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231028
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 9
DP  - 2023 Sep
TI  - Prognostic Significance of Diastolic Dysfunction in Type 2 Diabetes Mellitus 
      Patients With Sepsis and Septic Shock: Insights From a Longitudinal Tertiary Care 
      Study.
PG  - e45894
LID - 10.7759/cureus.45894 [doi]
LID - e45894
AB  - BACKGROUND: Sepsis is one of the leading contributors to global mortality and 
      morbidity, causing multi-organ failure, mainly involving cardiovascular failure, 
      both systolic and diastolic dysfunction, leading to adverse clinical outcomes. 
      There is little clinical data on the correlation with the mortality of patients 
      with type 2 diabetes mellitus (T2DM) with sepsis and septic shock and left 
      ventricular diastolic dysfunction. Our study sought to assess whether the 
      severity of diastolic dysfunction could predict 28-day mortality. METHODOLOGY: 
      The study included T2DM patients admitted to the intensive care unit (ICU) with 
      sepsis and septic shock defined according to the Third International Consensus 
      Definitions for Sepsis and Septic Shock at a tertiary care center in northern 
      India. A total of 132 patients (age = 61.01 +/- 13.12 years; 62% male; mean APACHE 
      II (Acute Physiology and Chronic Health Evaluation II) score = 25.74 +/- 4.79; 
      Sequential Organ Failure Assessment (SOFA) score = 12.34 +/- 3.36) underwent 
      transthoracic echocardiography within two hours of ICU admission till 28 days of 
      admission or till mortality occurred. Clinical variables (APACHE II and SOFA 
      score) and cardiac biomarkers, such as N-terminal pro-B-type natriuretic peptide 
      (NT-pro-BNP), troponin I, and creatine phosphokinase-MB, were measured at the 
      time of admission and after 72 hours to compare with mortality. Diastolic 
      dysfunction was defined according to the American Society of Echocardiography 
      (ASE) 2009 guidelines, classifying subjects into grade 0 (normal), if early 
      diastolic velocity (e') >/= 8 cm/s; grade 1 (impaired relaxation), if e' < 8 cm/s 
      and early (E) to late (A) ventricular filling velocities (E/A) ratio < 0.8; grade 
      2 (pseudo normal), if e' < 8 cm/s, E/A = 0.8-1.5, and peak E-wave velocity by the 
      peak e' velocity (E/e') ratio = 9-12; and grade 3 (restrictive), if e' < 8 cm/s, 
      E/A > 2, deceleration time (DT) < 160 ms, and E/e' >/= 13. RESULTS: Thirty-seven 
      (40.65%) out of 132 patients had diastolic dysfunction on initial 
      echocardiography, while 54 (59.34%) had diastolic dysfunction on at least 
      subsequent echocardiography. Total mortality was 68.93% with the highest 
      mortality (100%) observed among those with grade 3 diastolic dysfunction. The 
      28-day mortality with diastolic dysfunction in sepsis and septic shock patients 
      showed significant results (p < 0.001), indicating that with a higher E/A ratio 
      or higher grade of diastolic dysfunction with the increase in SOFA score, the 
      early ICU mortality is the highest and have the shortest duration of ICU stay 
      with mean +/- SD = 6.2 +/- 2.48, as compared to other grades with 100% mortality. 
      Also, the cardiac biomarker NT-pro-BNP was markedly elevated with a mean +/- SD 
      value of 503 +/- 269.3 pg/ml, indicating early predicted mortality. No correlation 
      was detected between mortality and the mean levels of fasting blood sugar, 
      postprandial blood sugar, and glycosylated hemoglobin. CONCLUSION: Our study 
      concluded that diastolic dysfunction is an important and strongest independent 
      mortality predictor in patients with T2DM with severe sepsis and septic shock, 
      and the higher the grade of diastolic dysfunction, the higher the mortality with 
      the lowest mean ICU stay.
CI  - Copyright (c) 2023, Thockchom et al.
FAU - Thockchom, Nonita
AU  - Thockchom N
AD  - Internal Medicine, All India Institute of Medical Sciences, Rishikesh, IND.
FAU - Bairwa, Mukesh
AU  - Bairwa M
AD  - Internal Medicine, All India Institute of Medical Sciences, Rishikesh, IND.
FAU - Kant, Ravi
AU  - Kant R
AD  - General Medicine, All India Institute of Medical Sciences, Rishikesh, IND.
FAU - Kumar, Barun
AU  - Kumar B
AD  - Cardiology, All India Institute of Medical Sciences, Rishikesh, IND.
FAU - Bahurupi, Yogesh
AU  - Bahurupi Y
AD  - Community and Family Medicine, All India Institute of Medical Sciences, 
      Rishikesh, IND.
FAU - Goyal, Bela
AU  - Goyal B
AD  - Biochemistry, All India Institute of Medical Sciences, Rishikesh, IND.
LA  - eng
PT  - Journal Article
DEP - 20230925
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10599194
OTO - NOTNLM
OT  - 2d echocardiography
OT  - icu mortality
OT  - left ventricular diastolic dysfunction
OT  - sepsis
OT  - septic shock
OT  - type 2 diabetes mellitus
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/10/27 06:42
MHDA- 2023/10/27 06:43
PMCR- 2023/09/25
CRDT- 2023/10/27 04:18
PHST- 2023/09/23 00:00 [accepted]
PHST- 2023/10/27 06:43 [medline]
PHST- 2023/10/27 06:42 [pubmed]
PHST- 2023/10/27 04:18 [entrez]
PHST- 2023/09/25 00:00 [pmc-release]
AID - 10.7759/cureus.45894 [doi]
PST - epublish
SO  - Cureus. 2023 Sep 25;15(9):e45894. doi: 10.7759/cureus.45894. eCollection 2023 
      Sep.