Right Ventricular Dysfunction Affects Short- and Long-Term Mortality in Sepsis

Right ventricular (RV) dysfunction is associated with higher short-term and long-term mortality in sepsis and septic shock, according to study results published in CHEST.

Recently, there has been an increasing emphasis on the cardiovascular outcomes of sepsis and septic shock. While left ventricular (LV) systolic and diastolic dysfunction have been extensively studied, there are limited data on RV dysfunction in patients with sepsis and septic shock. Therefore, researchers sought to determine whether RV function affects mortality in sepsis and septic shock by reviewing the published literature from January 1999 to April 2020 for studies evaluating adult patients with sepsis and septic shock.

A total of 10 studies were identified that included 1373 patients; 477 (34.7%) of whom had RV dysfunction. Right ventricular dysfunction was variably classified as decreased RV systolic motion, high RV/LV ratio, and decreased RV ejection fraction. Septic shock, acute respiratory distress syndrome (ARDS), and mechanical ventilation were reported 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.

The studies demonstrated moderate (I²=58%) and low (I²=49%) heterogeneity for short-term and long-term mortality, respectively. RV dysfunction was associated with higher short-term (odds ratio [OR]; 2.42; P =.0002; all 10 studies) and long-term (OR, 2.26; P=.004; 4 studies) mortality.

“In this large meta-analysis of 1373 patients with sepsis and septic shock, RV dysfunction was noted in nearly 35% of the population,” the study authors wrote. “Further mechanistic and preventative studies are needed to improve the clinical outcomes in this critically ill population.”

Reference

Vallabhajosyula S, Shankar A, Vojjini R, et al. Impact of right ventricular dysfunction on short- and long-term mortality in sepsis: a meta-analysis of 1,373 patients. CHEST. Published online December 23, 2021. doi:10.1016/j.chest.2020.12.016