Right ventricular (RV) dysfunction in sepsis and septic shock has been infrequently studied and has uncertain prognostic significance.
Does RV function impact mortality in sepsis and septic shock?
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 (intensive care unit 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.
Ten studies, including 1,373 patients were included, of which 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, acute respiratory distress syndrome and mechanical ventilation were noted in 82.0%, 27.5% and 78.4% of the population. Patients with RV dysfunction had lower rates of mechanical ventilation (71.9% vs. 81.9%; p<0.001), higher rates of acute hemodialysis (38.1% vs. 22.4%; p=0.04), but comparable rates of septic shock and acute respiratory distress syndrome. Studies showed moderate (I=58%) and low (I=49%) heterogeneity for short-term and long-term mortality, respectively. RV dysfunction was associated with higher short-term (pooled odds ratio 2.42 [95% confidence interval 1.52-3.85]; p=0.0002) (10 studies) and long-term [pooled odds ratio 2.26 [95% confidence interval 1.29-3.95]; p=0.004) (4 studies) mortality.
In this meta-analysis of observational studies, RV dysfunction was associated with higher short-term and long-term mortality in sepsis and septic shock.

Copyright © 2020. Published by Elsevier Inc.