Brief Overview about Cardiorenal Syndrome in Sepsis

Abstract

Background: Multi-organ dysfunction is seen in up to 45% of patients presenting with sepsis/septic shock and is associated with worse short-term outcomes and long-term organ dysfunction. Sepsis is frequently associated with cardiovascular and renal dysfunction and injury either in isolation or in combination. However, there are limited data on cardiorenal syndrome (CRS) in septic patients. CRS is defined as the primary dysfunction of either the heart or kidney resulting in secondary dysfunction or injury to the other organ and is classified into five types based on the chronicity and direction of ‘organ cross-talk’. CRS type 5 (CRS-5) reflects concomitant cardiac and renal dysfunction secondary to a systemic condition that affects both organs. Sepsis, cirrhosis, systemic lupus erythematosus, sarcoidosis, systemic sclerosis, amyloidosis, and toxins are all well-established causes of CRS-5. SCM is a consequence of hemodynamic alterations and changes in myocardial blood flow, in addition to direct myocardial toxicity from bacterial toxins. Under-resuscitation using intravenous fluids has been recognized to contribute to the traditional ‘cold shock’ in sepsis. However, modern literature has emphasized the role of judicious fluid resuscitation. Often restoration of vascular tone and adequate fluid loading unmasks left ventricular (LV) systolic dysfunction