A Multicenter Cross-sectional Study of Cardiac Ultrasound Phenotypes in Patients With Sepsis

Study Overview
=================
Brief Summary
-----------------
The heart, one of the most important organs for oxygen supply and consumption, is frequently involved in sepsis, i.e. septic cardiomyopathy, also known as septic myocardial suppression. The occurrence of septic myocardial suppression increases mortality in septic patients. Recent studies have found that left ventricular hyperdynamic state (EF > 70%) is associated with intra-ICU mortality in septic patients, possibly because it reflects unresolved vascular paralysis from sepsis . For septic myocardial suppression, there is still a lack of uniform criteria for diagnosis, but it is well established that the cardiac ultrasound phenotype of septic myocardial suppression can be left ventricular systolic insufficiency (LVSD), left ventricular diastolic insufficiency (LVDD), right ventricular insufficiency (RVD), diffuse ventricular insufficiency, and mixed ventricular insufficiency. According to incomplete statistics, the prevalence of LVSD ranges from 12 to 60%, the prevalence of LVDD is higher, 20% to 79%, and the prevalence of RVD varies from 30% to 55%. However, based on the current understanding of septic myocardial suppression, the relationship between each staging and its prognosis is unclear, and echocardiography can rapidly identify septic myocardial suppression and guide the classification of septic myocardial suppression to further optimize the diagnosis and treatment process of sepsis, especially to avoid over-resuscitation during fluid resuscitation and perform reverse resuscitation in a timely manner to improve patient prognosis and reduce hospitalization time. The aim of this study is to classify and evaluate the prognosis of patients with different septic cardiac ultrasound phenotypes in multiple centers across China by measuring the right and left heart systolic and diastolic indices by echocardiography, recording the baseline conditions and clinical indices of patients, and combining them with the prognosis.

Official Title
-----------------
A Multicenter Cross-sectional Study of Cardiac Ultrasound Phenotypes in Patients With Sepsis

Conditions
-----------------
Cardiac Ultrasound Phenotypes, Septic Myocardial Suppression, Hyperdynamic State Left Ventricular Function in Sepsis Patients, Outcome

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: - All patients with sepsis or septic shock who conform to Sepsis 3.0 diagnostic criteria Exclusion Criteria: Patients with preexisting chronic heart disease such as cardiomyopathy, chronic pulmonary heart disease, severe cardiac valve disease, coronary heart disease, congenital heart disease, pericardial disease, etc. and with cardiac function ≥ grade III (NYHA classification) prior to sepsis. End-stage malignancies. Severe trauma. Pregnancy. Patients for whom transthoracic echocardiography data are not available.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| left ventricular systolic dysfunction(LVSD)<br> | |
| left ventricular diastolic dysfunction(LVDD)<br> | |
| right ventricular dysfunction(RVD)<br> | |
| diffuse ventricular dysfunction<br> | |
| hyperdynamic state left ventricular function<br> | |
| Normal<br> | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| in-hospital mortality | Number of patient deaths divided by the total number | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 12 months | 
| 28-day mortality | Number of patient deaths within 28 days divided by the total number | From patient admission to day 28 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| length of stay in the ICU | Total number of days from patient transfer to ICU to transfer out of ICU | days from patient transfer to ICU to transfer out，an average of 1 week | 
| number of days of mechanical ventilation | Total number of days the patient was mechanically ventilated until the cessation of mechanical ventilation | Days the patient was mechanically ventilated until the cessation of mechanical ventilation，an average of 1 week |