Sepsis: right ventricular dysfunction is linked to mortality

  • Chest

  • von Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • In patients with sepsis and septic shock, this study found that right ventricular (RV) dysfunction was associated with higher 28-day mortality.
  • Prospective studies are needed.

Why this matters

  • RV dysfunction in this population is not well understood.
  • Severe septic cardiomyopathy can precede or accompany multiorgan failure.

Key results

  • 93 patients died.
  • Prevalences:
    • RV dysfunction: 48%.
    • Left ventricular (LV) dysfunction: 74%.
    • Isolated RV dysfunction: 9%.
  • On multivariate analysis, mortality risk (ORs; 95% CIs), with: 
    • RV dysfunction: 3.37 (1.67-6.78).
    • LV systolic dysfunction: 0.63 (0.32-1.24).
    • LV diastolic dysfunction: 1.26 (0.64-2.50).

Study design

  • Single-center, retrospective, observational study; secondary analysis of prospectively collected data (n=393).
  • Adults with severe sepsis or septic shock underwent transthoracic echocardiography for clinical indications within 24 hours of ICU admission.
  • RV dysfunction defined as either:
    • RV fractional area change  
    • Tricuspid annulus systolic plane excursion
  • Outcome: 28-day mortality.
  • Funding: Easton Family Fund; Intermountain Research and Medical Foundation.

Limitations

  • Studies performed by registered diagnostic cardiac sonographers.
  • Potential selection bias, as more stable patients may not have received echocardiography.
  • Unknown if cardiac dysfunction preceded sepsis.
  • Dysfunction definitions may have misclassified patients with borderline values.