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Multicenter Study
. 2025 Sep 1;53(9):e1759-e1769.
doi: 10.1097/CCM.0000000000006771. Epub 2025 Jul 2.

Association Between Initial Left Ventricular Systolic Dysfunction and Clinical Outcome in Sepsis: A Multicenter Cohort Study

Hyunseung Nam  1 , Ji Hyun Cha  1 , Ki Hong Choi  2 , Chi Ryang Chung  1 , Jeong Hoon Yang  1   2 , Gee Young Suh  1   3 , Sunghoon Park  4 , Chae-Man Lim  5 , Ryoung-Eun Ko  1 ; Korean Sepsis Alliance (KSA) Investigators
Collaborators, Affiliations
Multicenter Study

Association Between Initial Left Ventricular Systolic Dysfunction and Clinical Outcome in Sepsis: A Multicenter Cohort Study

Hyunseung Nam et al. Crit Care Med. .

Abstract

Objectives: To investigate the association between the severities of left ventricular (LV) systolic dysfunction and clinical outcomes in patients with sepsis, with a particular focus on in-hospital mortality.

Design: Multicenter cohort study.

Setting: Nineteen tertiary or university-affiliated hospitals in South Korea.

Patients: A total of 2274 adult patients with sepsis or septic shock underwent echocardiographic examination within 24 hours of sepsis recognition.

Interventions: None.

Measurements and main results: Patients were stratified by left ventricular ejection fraction (LVEF) into three groups: normal (> 50%, n = 1803), mild-to-moderate dysfunction (30-50%, n = 356), and severe dysfunction (< 30%, n = 115). In-hospital mortality is significantly associated with LV dysfunction severity (normal: 25.73%, mild-to-moderate: 29.49%, severe: 40.00%; p = 0.023). After propensity score matching using three different methodologies, severe LV dysfunction remained independently associated with increased in-hospital mortality (adjusted odds ratio [OR] 1.81; 95% CI, 1.09-3.03). This effect was more pronounced in patients without preexisting cardiovascular disease (CVD) (OR 1.84; 95% CI, 1.08-3.13) and those with bacteremia (OR 2.20; 95% CI, 1.5-3.22). Cardiopulmonary arrest rates increased significantly with dysfunction severity (normal: 2.11%, mild-to-moderate: 3.93%, severe: 10.43%; p < 0.001), while other ICU complications showed no significant differences.

Conclusions: Severe LV systolic dysfunction (LVEF < 30%) is associated with significantly increased in-hospital mortality in sepsis patients, particularly in those with bacteremia and without preexisting CVD. These findings highlight the importance of early cardiac function assessment in sepsis and suggest that infection status and underlying cardiovascular health modify the relationship between LV dysfunction and clinical outcome.

Keywords: bacteremia; cardiomyopathy; ejection fraction; left ventricular dysfunction; mortality; sepsis.

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Conflict of interest statement

Drs. Suh and Ko received support for article research from the Korean Disease Control and Prevention Agency. Dr. Park received support for article research from the Korean Ministry of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowchart of the study population. LV = left ventricle.
Figure 2.
Figure 2.
Subgroup analysis of mortality by left ventricular (LV) dysfunction severity.
See this image and copyright information in PMC

References

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