A Circulating Myocardial Depressant Substance is Associated with Cardiac Dysfunction and Peripheral Hypoperfusion: Results

In: Septic Shock

4 Nov 2014

Twenty-one of the 34 patients had positive blood cultures, two patients had abdominal abscesses, and the remaining 11 had localized infections with positive bacterial cultures or Gram stains that were judged diagnostic of infection. These 11 patients were all receiving broad-spectrum antibiotics during the time of their episodes of fever and hypotension, and the concomitant antibiotic therapy was thought to account (in part) for the negative blood cultures.
Fourteen of these 34 patients had positive assays for MDS (see above, described as a -20 percent or greater decrease in the extent of myocardial cell shortening comparing test with control sera) in one or more serially obtained blood samples.

This depressant activity usually could be demonstrated in sera obtained during the early phase of septic shock (iie, days 1 and 2); it was absent from sera obtained on day 3 or later. Twenty of the 34 patients had negative MDS assays of all serum samples obtained. The time between the onset of septic shock (onset defined as rigor, fever, or hypotension) and enrollment into the study protocol was equivalent in the patients with MDS (7.1 ±1.2 hs) and patients without MDS (6.2 ±2.2 hs). The distribution of underlying diseases did not differ between the two groups.

Of the 34 septic shock patients, seven died. Five of these seven (71 percent) had MDS. In comparison, only nine of the 27 survivors (33 percent) had MDS (0.05<p<0.10).
Two of the 50 patients enrolled in this study had cardiogenic shock, with low cardiac indices (<2 U min/m2) and high systemic vascular resistances (>2,000 dynes*s*cm). One of these patients had fun-gemia (blood cultures positive for Cryptococcus), with no enzymatic or ECG evidence of acute myocardial damage, and is included among the 14 patients with septic shock and positive MDS. The other patient had a myocardial infarction, was classified as critically ill but not septic, and was also positive for MDS.


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