Article of the Week: Sepsis-Induced Cardiogenic Shock (SICS)
Okay. Now I know what you are thinking: does the title really combine sepsis and cardiogenic shock into a single term?
SICS is an important concept, and the diagnostic criteria are a bid muddled for some. I for one don’t recall it being called SICS. It is basically a sepsis-induced cardiogenic shock.
This week’s article is from the 2025 Journal of Intensive Care and can be read here (or click the image below):
It’s a phenomenon we see too often: sepsis basically depressing myocardial function.
So how does it occur?
Sepsis most likely causes an imbalance in production of pro and anti-inflammatory cytokines
We know that cytokines and interleukins like TNF-alpha and IL-1-beta can synergistically cause myocardial depression. Also, anyone who has toiled during the initial year of COVID may have read (and seen firsthand) how IL-6 unregulated in COVID-19 and leads to myocardial inflammation.
Doctor’s Order: Outline the steps of myocardial dysfunction in sepsis
At the start of sepsis, the left ventricular ejection fraction or LVEF, is usually unhindered and baseline-normal. ➡️ yet there is high vascular permeability and high vasodilation from circulating toxin ➡️ this leads to insufficient cardiac preload ➡️ thus the SV or stroke volume is low. ➡️the HR picks up as there is further vascular permeability ➡️ the SV may recover ➡️ then LVEF eventually fails because of an increase in end diastolic volume.
The key here is deciding what the baseline LV function was before the critical illness. Refer to the blue algorithm (credit to the author) at the top of the post
Why does LVEF depress in sepsis?
Usually the depression of LVEF is temporary. This is thought to be in part due a higher LV end-diastolic volume.
References
Sato R, Hasegawa D, Guo S, Nuqali AE, Moreno JEP. Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management. J Intensive Care. 2025 Jan 2;13(1):1. doi: 10.1186/s40560-024-00770-y. PMID: 39748440; PMCID: PMC11694368.
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