Abstract

Diastolic dysfunction is a common manifestation of sepsis-associated cardiomyopathy and has been associated with poorer outcomes in critically ill patients; however, the factors that contribute to its development during septic shock are not fully defined. This study aimed to determine the association between cumulative fluid balance and diastolic dysfunction in patients with septic shock admitted to the ICU. An observational, prospective, longitudinal, and analytical study was conducted that included 55 adult patients with a diagnosis of septic shock. Cumulative fluid balance and diastolic function were assessed by critical echocardiography using the E/A ratio at admission, 24, and 72 hours. The statistical analysis included descriptive and analytical methods; ROC curves and relative risk calculation were used. It was identified that 40% of the patients had diastolic dysfunction. The most frequent infectious process was abdominal (60%), followed by pulmonary (32.7%). A positive and significant correlation was observed between the accumulated water balance and the  mitral E/A ratio at all times evaluated (admission: r=0.531; 24 h: r=0.560; 72 h: r=0.466; p<0.001). The relative risk of diastolic dysfunction increased with water balance: 5.4 times the risk at admission, 8.8 at 24 h, and 13.9 at 72 h. In conclusion, the risk of developing diastolic dysfunction consistently increases with the increase in accumulated water balance.

Keywords

Septic shock, diastolic dysfunction, fluid balance, and critical echocardiography