Clinical Research
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Fragmente QRS Paterni Sepsis ve Septik Şokta Kötü Prognozu Öngörür

Year 2024, Volume: 7 Issue: 3, 257 - 262, 27.10.2024

Abstract

Amaç: Sepsise bağlı miyokardiyal disfonksiyon, yüksek mortalite oranı ile ilişkili klinik bir durumdur. Parçalanmış QRS (fQRS) miyokardın fonksiyonu ile ilişkili bir belirteçtir. Bu çalışmanın amacı fQRS paternlerinin kısa dönem genel sağkalım (OS) ile ilişkili olup olmadığını belirlemektir.
Yöntem: Çalışmaya 76 sepsis ve 68 septik şok hastası dahil edildi. SOFA skoru ve APACHE II skoru hesaplandı ve fQRS paterni değerlendirildi.
Bulgular: Septik şok grubunda APACHE II skoru, SOFA skoru ve mortalite anlamlı olarak daha yüksekti [sırasıyla 38 (%50) vs 45 (%65); p<0.01]. Mekanik ventilasyon süresi, fQRS paterni ve hastanede yatış süresi mortaliteyi öngörmüştür. FQRS paterninin varlığı her iki grupta da kısa dönem sağkalımda azalma ile ilişkilendirilmiştir
Sonuç: fQRS paterni ve mortalite özellikle septik şoklarda anlamlı olarak daha yüksekti. Bununla birlikte, her iki grupta da fQRS varlığının mortalite ile korelasyon gösterdiği ve bağımsız olarak daha kötü OS'yi öngördüğü bulunmuştur. Bu nedenle, fQRS paterninin septik hastalar için yeni bir prognostik gösterge olabileceğini düşünüyoruz.

Ethical Statement

Etik Kurul Belgesi sisteme yüklenmiştir.

References

  • Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801-810. doi:10.1001/jama.2016.0287
  • Sato R, Nasu M. A review of sepsis-induced cardiomyopathy. J Intensive Care. 2015;3:48. doi:10.1186/s40560-015-0112-5
  • Esposito S, De Simone G, Boccia G, et al. Sepsis and septic shock: New definitions, new diagnostic and therapeutic approaches. J Glob Antimicrob Resist. 2017;10:204-212. doi:10.1016/j.jgar.2017.06.013
  • Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet. 2018;392(10141):75-87. doi:10.1016/S0140-6736(18)30696-2
  • Ren J, Wu S. A burning issue: do sepsis and systemic inflammatory response syndrome (SIRS) directly contribute to cardiac dysfunction? Front Biosci. 2006;11:15-22. doi:10.2741/1776
  • Hunter JD, Doddi M. Sepsis and the heart. Br J Anaesth. 2010;104:3-11. doi:10.1093/bja/aep339
  • Li X, Shi B, Chen X, et al. Fragmented QRS complex on a 12-lead electrocardiogram predicts cardiovascular and all-cause mortality in dialysis patients. Semin Dial. 2023;36(1):43-52. doi:10.1111/sdi.13055
  • Chatterjee S, Changavala N. Fragmented QRS a novel marker of cardiovascular disease. Clin Cardiol. 2010;33:68-71. doi:10.1002/clc.20709
  • Das MK, Khan B, Jacob S, et al. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113,2495-2501. doi:10.1161/Cırculatıonaha.105.595892
  • Sha J, Zhang S, Tang M, et al. Fragmented QRS is associated with all‐cause mortality and ventricular arrhythmias in patient with idiopathic dilated cardiomyopathy. Ann Noninvasive Electrocardiol. 2011;16:270-275. doi:10.1111/j.1542-474X.2011.00442.x
  • Ozcan S, Cakmak HA, Ikitimur B, et al. The prognostic significance of narrow fragmented QRS on admission electrocardiogram in patients hospitalized for decompensated systolic heart failure. Clinical Cardiology. 2013;36(9):560-564. doi:10.1002/clc.22158
  • Raja DC, Mehrotra S, Agrawal A, et al. Cardiac Biomarkers and Myocardial Dysfunction in Septicemia. J Assoc Physicians India. 2017;65(12):14-19.
  • Take Y, Morita H. Fragmented QRS: What is the meaning? Indian Pacing and Electrophysiology J. 2012;12:213-225. doi:10.1016/s0972-6292(16)30544-7
  • Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med. 2011;39(1):163-9. doi:10.1097/CCM.0b013e3181f96f81
  • Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:1754-1758. doi:10.1001/jama.286.14.1754
  • Beesley SJ, Weber G, Sarge T, et al. Septic cardiomyopathy. Crit Care Med. 2018;46(4):625-634. doi:10.1097/CCM.0000000000002851
  • Torgersen C, Moser P, Luckner G, et al. Macroscopic postmortem findings in 235 surgical intensive care patients with sepsis. Anesth Analg. 2009;108(6):1841-1847. doi:10.1213/ane.0b013e318195e11d
  • Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm. 2007;4:1385-92. doi:10.1016/j.hrthm.2007.06.024
  • Michael MA, El Masry H, Khan BR, et al. Electrocardiographic signs of remote myocardial infarction. Prog Cardiovasc Dis. 2007;50:198-208. doi:10.1016/j.pcad.2007.05.003
  • Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Curr Opin Cardiol. 2010;25:59-64. doi:10.1097/HCO.0b013e328333d35d
  • Mahenthiran J, Khan BR, Sawada SG, et al. Fragmented QRS complexes not typical of a bundle branch block: a marker of greater myocardial perfusion tomography abnormalities in coronary artery disease. J Nucl Cardiol. 2007;14: 347-353. doi:10.1016/j.nuclcard.2007.02.003
  • Altunova M, Püşüroğlu H, Karakayalı M, et al. Relationship Between Fragmented QRS Complex and Long-Term Cardiovascular Outcome in Patients with Essential Hypertension. Anatol J Cardiol. 2022;26(6):442-449. doi:10.5152/AnatolJCardiol.2022.1322
  • Karakayali M, Artac I, Omar T, et al. The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients. Blood Press Monit. 2023;28(2):96-102. doi:10.1097/MBP.0000000000000637
  • Omar T, Karakayalı M, Perincek G. Assessment of COVID-19 deaths from cardiological perspective. Acta Cardiol. 2022;77(3):231-238. doi:10.1080/00015385.2021.1903704

Fragmented QRS Pattern Predicts Poor Prognosis in Sepsis and Septic Shock

Year 2024, Volume: 7 Issue: 3, 257 - 262, 27.10.2024

Abstract

Objective: Myocardial dysfunction due to sepsis is a clinical condition associated with a high rate of mortality. Fragmented QRS (fQRS) is a marker that is associated with the function of the myocardium. This study aimed to determine whether fQRS patterns were associated with short-term overall survival(OS).
Methods: 76 patients with sepsis and 68 patients with septic shock were included in the study. SOFA score and APACHE II score were calculated, and the fQRS pattern has been assessed..
Results: In the septic shock group, APACHE II score, SOFA score and mortality were significantly higher [38 (%50) vs 45 (%65), respectively; p<0.01]. Duration of mechanical ventilation, the fQRS pattern, and hospitalization time predicted the mortality. The fQRS pattern's presence was linked to a decreased short-term survival in both groups
Conclusion: fQRS pattern and mortality were significantly higher especially septic shocks. However, in both groups, the presence of the fQRS has been found to have a correlation with mortality and independently predicted worse OS. Thus, we propose that the fQRS pattern could serve as a novel prognostic indicator for septic patients.

References

  • Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801-810. doi:10.1001/jama.2016.0287
  • Sato R, Nasu M. A review of sepsis-induced cardiomyopathy. J Intensive Care. 2015;3:48. doi:10.1186/s40560-015-0112-5
  • Esposito S, De Simone G, Boccia G, et al. Sepsis and septic shock: New definitions, new diagnostic and therapeutic approaches. J Glob Antimicrob Resist. 2017;10:204-212. doi:10.1016/j.jgar.2017.06.013
  • Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet. 2018;392(10141):75-87. doi:10.1016/S0140-6736(18)30696-2
  • Ren J, Wu S. A burning issue: do sepsis and systemic inflammatory response syndrome (SIRS) directly contribute to cardiac dysfunction? Front Biosci. 2006;11:15-22. doi:10.2741/1776
  • Hunter JD, Doddi M. Sepsis and the heart. Br J Anaesth. 2010;104:3-11. doi:10.1093/bja/aep339
  • Li X, Shi B, Chen X, et al. Fragmented QRS complex on a 12-lead electrocardiogram predicts cardiovascular and all-cause mortality in dialysis patients. Semin Dial. 2023;36(1):43-52. doi:10.1111/sdi.13055
  • Chatterjee S, Changavala N. Fragmented QRS a novel marker of cardiovascular disease. Clin Cardiol. 2010;33:68-71. doi:10.1002/clc.20709
  • Das MK, Khan B, Jacob S, et al. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113,2495-2501. doi:10.1161/Cırculatıonaha.105.595892
  • Sha J, Zhang S, Tang M, et al. Fragmented QRS is associated with all‐cause mortality and ventricular arrhythmias in patient with idiopathic dilated cardiomyopathy. Ann Noninvasive Electrocardiol. 2011;16:270-275. doi:10.1111/j.1542-474X.2011.00442.x
  • Ozcan S, Cakmak HA, Ikitimur B, et al. The prognostic significance of narrow fragmented QRS on admission electrocardiogram in patients hospitalized for decompensated systolic heart failure. Clinical Cardiology. 2013;36(9):560-564. doi:10.1002/clc.22158
  • Raja DC, Mehrotra S, Agrawal A, et al. Cardiac Biomarkers and Myocardial Dysfunction in Septicemia. J Assoc Physicians India. 2017;65(12):14-19.
  • Take Y, Morita H. Fragmented QRS: What is the meaning? Indian Pacing and Electrophysiology J. 2012;12:213-225. doi:10.1016/s0972-6292(16)30544-7
  • Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med. 2011;39(1):163-9. doi:10.1097/CCM.0b013e3181f96f81
  • Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:1754-1758. doi:10.1001/jama.286.14.1754
  • Beesley SJ, Weber G, Sarge T, et al. Septic cardiomyopathy. Crit Care Med. 2018;46(4):625-634. doi:10.1097/CCM.0000000000002851
  • Torgersen C, Moser P, Luckner G, et al. Macroscopic postmortem findings in 235 surgical intensive care patients with sepsis. Anesth Analg. 2009;108(6):1841-1847. doi:10.1213/ane.0b013e318195e11d
  • Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm. 2007;4:1385-92. doi:10.1016/j.hrthm.2007.06.024
  • Michael MA, El Masry H, Khan BR, et al. Electrocardiographic signs of remote myocardial infarction. Prog Cardiovasc Dis. 2007;50:198-208. doi:10.1016/j.pcad.2007.05.003
  • Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Curr Opin Cardiol. 2010;25:59-64. doi:10.1097/HCO.0b013e328333d35d
  • Mahenthiran J, Khan BR, Sawada SG, et al. Fragmented QRS complexes not typical of a bundle branch block: a marker of greater myocardial perfusion tomography abnormalities in coronary artery disease. J Nucl Cardiol. 2007;14: 347-353. doi:10.1016/j.nuclcard.2007.02.003
  • Altunova M, Püşüroğlu H, Karakayalı M, et al. Relationship Between Fragmented QRS Complex and Long-Term Cardiovascular Outcome in Patients with Essential Hypertension. Anatol J Cardiol. 2022;26(6):442-449. doi:10.5152/AnatolJCardiol.2022.1322
  • Karakayali M, Artac I, Omar T, et al. The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients. Blood Press Monit. 2023;28(2):96-102. doi:10.1097/MBP.0000000000000637
  • Omar T, Karakayalı M, Perincek G. Assessment of COVID-19 deaths from cardiological perspective. Acta Cardiol. 2022;77(3):231-238. doi:10.1080/00015385.2021.1903704
There are 24 citations in total.

Details

Primary Language English
Subjects Intensive Care
Journal Section Research Articles
Authors

Pınar Karabacak 0000-0002-6210-5962

Mustafa Karabacak 0000-0001-6879-5522

Özlem Polat 0000-0003-3806-5574

Yağmur Kara 0000-0003-4117-0455

Publication Date October 27, 2024
Submission Date January 2, 2024
Acceptance Date August 1, 2024
Published in Issue Year 2024 Volume: 7 Issue: 3

Cite

AMA Karabacak P, Karabacak M, Polat Ö, Kara Y. Fragmented QRS Pattern Predicts Poor Prognosis in Sepsis and Septic Shock. Acta Med Nicomedia. October 2024;7(3):257-262.

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