Bedside predictors of left ventricular systolic dysfunction in children with suspected infection undergoing cardiac ultrasound.

backgroundLeft ventricular systolic dysfunction in children with suspected infection can worsen outcomes and complicate early management of sepsis. Cardiac ultrasound enables bedside assessment of ventricular function, but it remains unclear which bedside markers are associated with an increased risk of myocardial dysfunction.

objectiveTo identify which bedside markers commonly incorporated into pediatric sepsis assessment are associated with reduced left ventricular systolic function on cardiac ultrasound in children with suspected infection.

methodsIn this retrospective cohort study, we included patients aged 1 month to 21 years with suspected infection who had documented heart rate and blood pressure within 6 h of emergency department presentation and underwent cardiac ultrasound assessment (CUS), defined as either cardiac point of care ultrasound (POCUS) or transthoracic echocardiography (TTE), within 24 h (N = 2046). Patients whose CUS was performed after initiation of vasoactive therapy were excluded. Reduced left ventricular systolic function was defined as either qualitative assessment of reduced function on expert reviewed cardiac POCUS or a left ventricular ejection fraction <50% on TTE. A multivariable logistic regression model assessed associations between bedside markers included in commonly used pediatric sepsis assessment tools (tachycardia, systolic hypotension, altered mental status, capillary refill time [CRT], and a high risk condition) and reduced left ventricular systolic function. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated.

resultsAmong 2046 eligible patients undergoing CUS, 89 (4.3%) had reduced left ventricular systolic function. In multivariable analysis, systolic hypotension (aOR 2.16, 95% CI 1.00 to 4.65) and prolonged capillary refill time (CRT 3 s, aOR 1.84, 95% CI 1.03 to 3.28; CRT ≥4 s, aOR 2.22, 95% CI 0.98 to 5.03) were associated with reduced left ventricular systolic function. Tachycardia (aOR 0.79, 95% CI 0.50 to 1.26), altered mental status (aOR 1.18, 95% CI 0.63 to 2.21), and a high risk condition (aOR 1.19, 95% CI 0.69 to 2.05) were not associated with reduced function.

conclusionsReduced left ventricular systolic function on cardiac ultrasound among children with suspected infection was uncommon but associated with systolic hypotension and prolonged capillary refill time. Notably, it was not associated with tachycardia alone. These findings suggest that systolic hypotension and prolonged capillary refill are bedside markers associated with an increased risk of myocardial dysfunction and may help inform the selective use of cardiac ultrasound during the early evaluation of children with suspected infection. Prospective studies are needed to validate these findings.