Quantification and Prognostic Relevance of Vascular and Cardiac Dysfunction in Septic MODS – The Role of SOFA Score, Systemic Vascular Resistance (SVR) Score and Afterload-Related Cardiac Performance

A. Kirsten (Halle (Saale))¹, K. Werdan (Halle (Saale))², D. Hoyer (Halle (Saale))¹, R. Kolthoum (Halle (Saale))¹, D. G. Sedding (Halle (Saale))¹, A. Vogt (Halle (Saale))^1
1Universitätsklinikum Halle (Saale) Klinik und Poliklinik für Innere Medizin III Halle (Saale), Deutschland; ²Universitätsklinikum Halle (Saale) Klinik und Poliklinik für Innere Medizin III - Forschungslabor Halle (Saale), Deutschland

Sepsis and septic shock can be classied as septic multiple organ disease syndrome („septic MODS“). Documentation of the severity of septic MODS and therapeutic success or non-success needs best quantification of the respective organ failures, for which the SOFA score is widely used. Cardiovascular (CV) organ failure – characterized by the SOFA-CV subscore – plays a prominent, prognostically highly relevant role in septic MODS.

We hypothesized that for the vascular failure (vasoplegia) a systemic vascular resistance (SVR) score and for the cardiac pump failure in relation to afterload reduction an afterload-related cardiac performance (ACP) score can describe better the correlation of cardiovascular organ failure with ICU mortality of the patients. than the SOFA-CV subscore. In a prospectie manner we tested our hypothesis in a monocentric registry with 112 invasively monitored septic MODS patients. The following results were obtained:

1. The prominent vasoplegia in sepsis/septic shock can be quantifed by the SVR score with grading by SVR. The prognostic relevance (ICU mortality), however, is low (AUROC 0.551; P = 0.335).
2. The very complex septic cardiac dysfunction – systolic and diastolic dysfunction of the left as well as of the right ventricle - can be quantified by the ACP score which represents the cardiac output (CO) of the patient‘s heart („CO measured“) given as percentage of CO an uninjured heart would pump („CO predicted“) at the very same SVR of the patient. One third of the patients had normal or nearly normal cardiac function (ACP > 80 %) with an ICU mortality of about 25 %, while patients with an ACP < 60 % had a mortality of more than 80 %. The prognostic relevance of the ACP score is highly significant (P < 0.001; AUROC 0.77).
3. The combined SVR-ACP score has comparable, but not additional prognostic relevance than the ACP score.
4. From the components of the SOFA score, only the respiratory, the cardiovascular (CV) and the liver subscores had significant prognostic relevance, but not the renal, coagulation and CNS subscores. However, the SOFA-CV subscore (AUROC 0.632) adds only little prognostic relevance to the SOFA score (AUROC 0.704). Substitution of the SOFA-CV-subscore with the ACP score did improve the prognostic relevance of the SOFA score from AUROC 0.704 to AUROC 0.752 (P = 0.0189).
5. In summary: Severity of septic cardiac dysfunction as quantified by the ACP score clearly correlates with ICU mortality. Substituting SOFA-CV subscore with the ACP score would significantly improve the prognostic relevance of the SOFA score for ICU mortality.