Comparing Outcomes Of Non-Ischemic Cardiomyopathy And Ischemic Cardiomyopathy In Patients Admitted With Sepsis: A Nationwide Analysis

Abstract

Introduction

Sepsis poses a significant threat to individuals with underlying cardiac conditions, including non-ischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM). This retrospective observational study compares in-hospital outcomes and complications between septic patients with NICM and ICM.

Methods

Data was obtained from the Nationwide Inpatient Sample database from January 2016 to December 2020. The study included all adult patients who had sepsis as their primary discharge diagnosis and also had a concomitant diagnosis of NICM or ICM. These two groups were then compared. The primary outcome of our study was inpatient mortality. Secondary outcomes were cardiac arrest, arrhythmias, acute respiratory failure, and acute renal failure, as well as the need for transfusions, pressors, ventilators, tracheostomy, and ECMO.

Results

The study included 117,031 patients, among whom 69.1% had NICM and 30.9% had ICM. In-hospital mortality rates were significantly different between the two groups, with NICM patients having 13% higher odds of mortality after adjusting for age, sex, race, and Charlson's Comorbidity Index (aOR [95% CI] = 1.13 [1.01-1.28], p < 0.001). Furthermore, they also had a significantly higher risk of acute renal failure(aOR: 1.03; p<0.05), and acute respiratory failure (aOR: 1.18; p<0.001). They also had a higher need for life-saving treatments like the use of mechanical ventilation (aOR: 1.23; p<0.001), pressors (aOR: 1.14; p<0.001), blood transfusions(aOR: 1.15; p<0.001) and tracheostomy (aOR: 1.55;p<0.001). However, this group had a lower risk of ventricular arrhythmias (aOR:0.88;p<0.001). There was no significant difference in the risk of cardiac arrest, need for dialysis or ECMO.

Conclusion

Our study sheds light on the distinct clinical trajectories of septic patients with non-ischemic cardiomyopathy versus ischemic cardiomyopathy. Patients with the former form of cardiomyopathy had significantly worse inpatient outcomes compared to the latter during the state of sepsis. Further research is warranted to elucidate the underlying mechanisms of this interesting finding. Doing this could potentially help us find better interventions and improve outcomes.