Sepsis in the ICU-II

Summary

Sepsis-induced cardiac dysfunction (SIMD) is a well-known phenomenon yet its diagnosis remains elusive with no accepted definition, or defining pathophysiological mechanism associated with this disease. Systolic dysfunction occurs in 20-70% of patients, and may be severe, yet does not appear to have any prognostic value for mortality. Diastolic function has also been variably described and seems to be related to short-term mortality. However, the contribution of left ventricular systolic and diastolic dysfunction to mortality in sepsis are still far from clear, with uncertain contribution from previous cardiovascular disease, vasopressor and inotropic drugs and mechanical ventilation. Another poorly investigated area is right ventricular dysfunction. Cor pulmonale occurs in up to 25% of patients with septic shock, and is invariably related to pulmonary haemodynamics and mechanical ventilation, yet very little is known about how this affects prognosis. Finally, although the outcome of disease is a function of multiple parameters, septic cardiomyopathy is most frequently characterized based on individual echocardiographic parameters, without considering their interactions or placing them in the context of biomarkers and clinically available haemodynamic data. Available relevant studies are often monocentric, and many fail to consider the various confounders that influence the clinical outcome in sepsis. Therefore, the diagnostic and prognostic value of combinations of clinical, biochemical and haemodynamic variables remains to be established.

Accordingly, the purpose of this study is to identify biomarkers and echocardiographic and haemodynamic signatures characteristic of specific outcomes in SIMD to support the diagnosis and prognosis in SIMD. Specific aims are:

1. To determine the association between left ventricular systolic and diastolic dysfunction, and adverse outcome in SIMD;
2. To determine the association between right ventricular systolic and diastolic dysfunction, and adverse outcome in SIMD;
3. To determine the association between novel biomarkers and adverse outcome in SIMD;
4. To determine the combined value of biomarker, echocardiographic, and haemodynamic variables for predicting adverse outcomes in SIMD;
5. To explore if there are different phenotypes of SIMD using unsupervised machine learning algorithms, and whether they are associated with adverse outcomes.

50 patients will be enrolled in a feasibility study to evaluate the logistical setup for acute echocardiography and biobanking facilities. A further 280 patients will be enrolled with inclusion from peripheral centers once feasibility is confirmed.

Note 15 Mar 2026: typing mistake noted in prior text, the sample size was originally for 330 patients (i.e. 50 + 280), not 350 (50 + 300) patients.

Conditions

• Septic Shock
• Sepsis
• Cardiomyopathies
• Organ Failure, Multiple

Interventions

OTHER

Exposure is septic shock (defined according to Sepsis-III) and standard treatment according to departmental protocols.

Collection of data, biomarker and echocardiography analysis will be centralized and blinded. Assessment of endpoints will be blinded.

Sponsors & Collaborators

• Centre Hospitalier Universitaire Dijon

  collaborator OTHER

• Ryhov County Hospital

  collaborator OTHER

• Bicetre Hospital

  collaborator OTHER

• European Georges Pompidou Hospital

  collaborator OTHER

• Linkoeping University

  lead OTHER_GOV

Principal Investigators

• Michelle Chew, MBBS, PhD · Linkoeping University Hospital

• Bernard Cholley, MD, PhD · CHU George Pompidou

• Belaid Bouhemad, MD, PhD · CHU Dijon

• Fredrik Hammarsköjld, MD, PhD · Ryhov Hospital, Jönköping

• Xavier Monnet, MD, PhD · Hopital Bicetre

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2018-09-17

Primary Completion

2026-02-11

Completion

2027-12-31

Countries

• France
• Sweden

Study Locations