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Review
. 2021 Jun;159(6):2254-2263.
doi: 10.1016/j.chest.2020.12.016. Epub 2021 Feb 27.

Impact of Right Ventricular Dysfunction on Short-term and Long-term Mortality in Sepsis: A Meta-analysis of 1,373 Patients

Saraschandra Vallabhajosyula  1 , Aditi Shankar  2 , Rahul Vojjini  3 , Wisit Cheungpasitporn  4 , Pranathi R Sundaragiri  5 , Hilary M DuBrock  6 , Hiroshi Sekiguchi  7 , Robert P Frantz  3 , Hector R Cajigas  7 , Garvan C Kane  3 , Jae K Oh  3
Affiliations
Review

Impact of Right Ventricular Dysfunction on Short-term and Long-term Mortality in Sepsis: A Meta-analysis of 1,373 Patients

Saraschandra Vallabhajosyula et al. Chest. 2021 Jun.

Abstract

Background: Right ventricular (RV) dysfunction in sepsis and septic shock has been infrequently studied and has uncertain prognostic significance.

Research question: Does RV function impact mortality in sepsis and septic shock?

Study design and methods: We reviewed the published literature from January 1999 to April 2020 for studies evaluating adult patients with sepsis and septic shock. Study definition of RV dysfunction was used to classify patients. The primary outcome was all-cause mortality divided into short-term mortality (ICU stay, hospital stay, or mortality ≤30 days) and long-term mortality (>30 days). Effect estimates from the individual studies were extracted and combined, using the random-effects, generic inverse variance method of DerSimonian and Laird.

Results: Ten studies, 1,373 patients, were included; RV dysfunction was noted in 477 (34.7%). RV dysfunction was variably classified as decreased RV systolic motion, high RV/left ventricular ratio and decreased RV ejection fraction. Septic shock, ARDS, and mechanical ventilation were noted in 82.0%, 27.5%, and 78.4% of the population, respectively. Patients with RV dysfunction had lower rates of mechanical ventilation (71.9% vs 81.9%; P < .001), higher rates of acute hemodialysis (38.1% vs 22.4%; P = .04), but comparable rates of septic shock and ARDS. Studies showed moderate (I2 = 58%) and low (I2 = 49%) heterogeneity for short-term and long-term mortality, respectively. RV dysfunction was associated with higher short-term (pooled OR, 2.42; 95%CI, 1.52-3.85; P = .0002) (10 studies) and long-term (pooled OR, 2.26; 95%CI, 1.29-3.95; P = .004) (4 studies) mortality.

Interpretation: In this meta-analysis of observational studies, RV dysfunction was associated with higher short-term and long-term mortality in sepsis and septic shock.

Keywords: critical care echocardiography; right ventricular dysfunction; sepsis; septic cardiomyopathy; septic shock.

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Figures

Figure 1
Figure 1
Literature search strategy using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2
Figure 2
Duval and Tweedie Trim and Fill Method funnel plot analysis of publication bias. A, Short-term mortality; B, long-term mortality.
Figure 3
Figure 3
A, Short-term and B, long-term mortality in sepsis and septic shock with and without right ventricular dysfunction.
See this image and copyright information in PMC

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