LAUSR

Introduction/Hypothesis: Left ventricular assist devices (LVADs) have become an integral management tool for patients with stage D heart failure. Traditional markers of sepsis are difficult to interpret in the LVAD population as they are likely to have altered hemodynamics at baseline and the LVAD itself may alter end organ parameters, which are commonly used to identify sepsis early. Our study aimed to identify which traditional sepsis markers and end organ parameters are associated with the presence of true sepsis in the LVAD population. This will aid clinicians in discerning the presence of a true infection early, employ tailored management, and decreased healthcare utilization. Methods: Retrospective study of inpatient admissions for LVAD patients over one year. Each admission was considered an “encounter”. Two groups were compared. Baseline group, “alerts”, included patient encounters that were positive for systemic inflammatory response syndrome (SIRS) based off abnormal temperature (> 38.3C or < 36.0C), white blood cell count (WBC > 12 or < 4 x 10 9 cells/L), tachypnea (> 20 breaths/min) or tachycardia (> 90 beats/min). If these SIRS encounters ultimately identified a true infection, provider documentation and/ or ICD coding for sepsis, these baseline “alerts” moved to the comparison group, “cases”. Otherwise patients remained in the control group as “alerts”. The comparison group, “cases”, represented the encounters captured by the SIRS system as well as those diagnosed with sepsis. Traditional demographic variables were measured. LVAD type and history mediastinal surgery and death events were analyzed as well. Variables traditionally indicative for sepsis with end organ dysfunction were measured in both grou Results: 115 patient encounters were included with 80 ‘alerts’ and 35 ‘cases’. Diabetes and chronic kidney disease were more prevalent in the sepsis cases. Traditional sepsis markers were recorded and significant differences were seen in temperature, WBC, respiratory rate, and INR. Lactic acidosis was not significantly different in the two groups. Conclusions: With an increase in LVAD use for treatment of stage D heart failure, sepsis is also likely to rise. Our study identified markers of true sepsis in this population. We hope to aid clinicians to use this information in the early recognition of sepsis.