What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Sepsis and septic shock. Intervention: Left ventricular global longitudinal strain (LVGLS) vs. Survivors vs Non-survivors. Primary outcome: Short-term mortality (difference in LVGLS) (SMD -0.40, 95% CI -0.62 to -0.18).

What does this research mean for the field?

In patients with sepsis, left ventricular global longitudinal strain is significantly more impaired in non-survivors than survivors, whereas left ventricular ejection fraction is not associated with short-term mortality. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This meta-analysis assesses the prognostic value of LVEF and LVGLS in predicting short-term mortality in sepsis patients.

May 17, 2026Open Access

Prognostic value of left ventricular ejection fraction and global longitudinal strain for short-term mortality in sepsis: a systematic review and meta-analysis

Key Result

In patients with sepsis, left ventricular global longitudinal strain was significantly more impaired in non-survivors than survivors (SMD -0.40), whereas left ventricular ejection fraction was not associated with short-term mortality.

Key Points

This meta-analysis assesses the prognostic value of LVEF and LVGLS in predicting short-term mortality in sepsis patients.
Systematic search of PubMed, Embase, Web of Science, and Cochrane Library until January 19, 2026.
Cohort studies assessing echocardiographic parameters and short-term mortality in adult sepsis were included.
Random-effects meta-analysis with standardized mean differences was performed.
LVGLS was significantly more impaired in non-survivors than survivors (SMD -0.40, 95% CI -0.62 to -0.18).
In septic shock-only analysis, LVGLS association persisted (SMD -0.76, 95% CI -1.01 to -0.51).
LVEF showed no significant association with short-term mortality (SMD 0.06, 95% CI -0.08 to 0.20).

Study Design

Type

Meta-Analysis

Structured PICO

Does impaired LVGLS predict short-term mortality in adult sepsis patients?

Population

Adult sepsis patients (9 cohort studies)

Intervention

Echocardiographic assessment of left ventricular global longitudinal strain (LVGLS) and left ventricular ejection fraction (LVEF)

Comparator

Survivors vs. non-survivors

Outcome

Short-term mortalityhard clinical

LVGLS, but not LVEF, is significantly associated with short-term mortality in adult sepsis patients, providing incremental prognostic information.

Main Result

Effect estimate: SMD -0.40 (95% CI -0.62 to -0.18)

Limitations

Inconsistent reporting of key clinical variables such as illness-severity scores, lactate levels, vasoactive dosing, and pre-existing cardiac comorbidities
Most studies reported unadjusted continuous comparisons rather than adjusted effect estimates
Heterogeneous reporting formats limited pooling of adjusted associations
Variability in vendor platforms and speckle-tracking software may have introduced measurement heterogeneity
Inconsistent reporting of imaging timing and clinical support

Abstract

BACKGROUND: Sepsis is a critical condition that leads to significant morbidity and mortality. Accurate prediction of patient outcomes is essential for effective management. This meta-analysis evaluates the prognostic value of echocardiographic cardiac function parameters, particularly left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (LVGLS), in predicting short-term outcomes in sepsis patients. METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted from inception to January 19, 2026, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort studies assessing echocardiographic parameters and short-term mortality in adult sepsis were included. Random-effects meta-analysis was performed using standardized mean differences (SMDs). Sensitivity analyses included leave-one-out procedures and restricted maximum likelihood with Hartung-Knapp adjustment. Publication bias was evaluated using funnel plots and Egger's regression test. RESULTS: Nine cohort studies published between 2014 and 2021 were included. LVGLS was significantly more impaired in non-survivors than in survivors (SMD - 0.40, 95% confidence interval CI - 0.62 to - 0.18; I² = 51.1%). Results remained robust with Hartung-Knapp adjustment (SMD - 0.55, 95% CI - 0.79 to - 0.30). In a septic shock-only sensitivity analysis, the association persisted (SMD - 0.76, 95% CI - 1.01 to - 0.51; I² = 0%). Subgroup analysis showed no significant difference between Sepsis-2 and Sepsis-3 studies (P = 0.45). LVEF was not associated with short-term mortality (SMD 0.06, 95% CI - 0.08 to 0.20; I² = 27.2%). Funnel plot inspection showed no clear asymmetry, and Egger's test was not statistically significant. CONCLUSIONS: LVGLS is associated with short-term mortality in sepsis and may provide incremental prognostic information beyond conventional LVEF assessment. Prospective studies are needed to define clinically meaningful thresholds and evaluate incremental value over established risk scores.

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