Myocardial depression in sepsis Patient analysis

Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Early detection and antibiotic treatment of sepsis are critical for improving sepsis outcomes, where each hour of delayed treatment has been associated with roughly an 4-8% increase in mortality

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. In a typical year:

• At least 1.7 million adults in America develop sepsis.

• At least 350,000 adults who develop sepsis die during their hospitalization or are discharged to hospice.

• 1 in 3 people who dies in a hospital had sepsis during that hospitalization

• Sepsis, or the infection causing sepsis, starts before a patient goes to the hospital in nearly 87% of cases.

Stages of Sepsis:

Myocardial depression in sepsis: from pathogenesis to clinical manifestations

The cardiovascular system plays a key role in sepsis, and septic myocardial depression is a common finding associated with increased morbidity and mortality. Myocardial depression during sepsis is not clearly defined, but it can perhaps be best described as a global (systolic and diastolic) dysfunction of both the left and right sides of the heart. The pathogenesis of septic myocardial depression involves a complex mix of systemic (hemodynamic) factors and genetic, molecular, metabolic, and structural alterations.

Myocardial depression is computed based on hemodynamic factors which affect how well your blood flows. Hemodynamic factors include Cardiac output, Heart rate, The size (diameter) of a blood vessel, Blood vessel expansion and contraction in response to blood pressure changes, Pressure differences between how forcefully your heart pumps and how much resistance your blood vessels provide. In this dataset cardiac output, heart rate, Troponin ,HBP is considered for calculation purpose, because troponin plays major role in cardiovascular disease during sepsis, the impact abnormal troponin will be long even after sepsis recovery so troponin is considered.

Calculation used to find Hemodynamic factors:

countd(IF ([Sepsis Label]=1 and ([cardiac output]>4.0 and [cardiac output]<8.0) and [Abnormal heart rate]=1 or [Highbloodpressure]=1 or [Troponin]=1) then [Patient ID] END) Highbloodpressure: {FIXED [Patient ID]:max(IF [SBP]>120 then 1 end)} Tropinin{INCLUDE [Patient ID]:max(IF [Troponin I]>0.04 then 1 else 0 END)} Abnormal heart rate :{FIXED [Patient ID]:max(IF [HR]>100 and [HR]<60 then 1 END)} Cardiac Output: {fixed [Patient ID]:MAX([HR]*(([PulsePressure])/([SBP]+[DBP])))} PulsePressure: {fixed [Patient ID]:AVG([SBP])-AVG([DBP])}

If the patient have sepsis and cardiac output is abnormal, high BP, Troponin is abnormal and cardiac output is calculated based on HR ,SBP ,DBP and Pulse pressure. In this dataset there is no pulse pressure so it is calculated based on SBP and DBP. Hemodynamic factors applied on ICU classification and Age Classification along with gender.

ICU LOS in days:

Depression of patient is based on Length of Stay in Hospital, the average number stay in ICU is 14 days. In this dataset ICULOS is available on hours. So the hours are converted into days by using below formula.

{fixed [Patient ID]:MAX([Iculos]/24)}

Depression classification:

IF ICULOS is above 10 days is High depression ,between 9 to 5 days considered as Moderate depression and below 5 is considered as Low depression.

ICU_LOS classification:

{fixed [Patient ID]:MAX(IF([ICU_LOS in days]>=10) THEN 1 ELSEIF [ICU_LOS in days]<10 and [ICU_LOS in days]>=5 then 2 else 3 END )}

CASE [ICU_LOS classification]

WHEN 1 then "High depression"

WHEN 2 THEN "Moderate depression"

When 3 then "Low depression"

END

Age Classification:

if([Age]>60) then 'senior people'

elseif([Age]<60 and [Age]>40) then 'almost senior'

elseif ([Age]<40 and [Age]>20) then 'adult'

elseif ([Age]<20) then 'paediatric'

END

Myocardial Depression on sepsis patient is found by ICU LOS, hemodynamic factors and Age.

In this Visualization, Bar and Line chart has been used to show myocardial depression in sepsis patient count.

Conclusion:

Myocardial depression is a common yet reversible phenomenon that occurs in patients during sepsis and septic shock. This analysis will be useful for doctor to predict early stage,otherwise the patient may get Hypotension in septic shock, this may leads to mortality in septic shock or morbidity in sepsis stage. This early myocardial depression prediction may reduce mortality rate.