Key result
High right ventricular injury score linked to ~7-fold higher 30-day mortality in sepsis.
Why the study?
To investigate the prognostic value of an RV injury score based on RV dilation, RV systolic dysfunction, and RV-PA decoupling, and explore its utility to grade RV dysfunction severity in septic patients.
Does a novel echocardiography-based Right Ventricular Injury (RVI) score predict 30-day mortality in adult septic patients?
Observational (n=327)
No
Does a novel echocardiography-based Right Ventricular Injury (RVI) score predict 30-day mortality in adult septic patients?
A novel echocardiography-based Right Ventricular Injury score effectively grades RV dysfunction severity and strongly predicts 30-day mortality in septic ICU patients.
Answers are grounded in this paper and cite their sources.
May aid risk stratification in septic ICU patients; hypothesis-generating and requires prospective validation before clinical use.
AIMS: We aim to investigate the prognostic value of a right ventricular (RV) injury score based on the concept of RV dilation, RV systolic dysfunction, and RV-pulmonary arterial (PA) decoupling in septic patients and to explore whether the RV injury (RVI) score can be used to grade the severity of RV dysfunction in these patients. METHODS AND RESULTS: Septic patients admitted to the ICU were prospectively included. We collected haemodynamic and echocardiographic parameters as well as prognostic information. RV dilation was defined as right and left ventricular end-diastolic area ratio (R/LVEDA) > 2/3. RVSD was defined as tricuspid annular plane systolic excursion (TAPSE) < 17 mm, right ventricular fractional area change (FAC) < 35%, or peak velocity of tricuspid annulus via tissue Doppler (S') < 10 cm/s. RV-PA decoupling was represented by the TAPSE/pulmonary arterial systolic pressure (PASP) ratio. RVI score were determined by the presence of the following findings: RVSD, RV dilation, and RV-PA decoupling, that is, one point for each finding. A total of 327 patients were enrolled in this study, among whom 276 survived and 51 died at 30 days after admission. Overall, 18.0% had RV dilation, 35.8% had RVSD, and 21.4% had RV-PA decoupling, with an appreciable overlap present. A multivariate Cox regression analysis showed that RV dilation (HR: 2.19, 95% CI: 1.19-4.01, P = 0.011), RVSD (HR: 2.25, 95% CI: 1.23-4.13, P = 0.009) and RV-PA decoupling (HR: 2.08, 95% CI: 1.19-3.65, P = 0.011) were independently associated with a 30 day mortality. Furthermore, RVI score was also an independent predictor, displayed additive effect with respect to 30 day mortality (RVI score 1 vs. RVI score 0, HR: 2.94, 95% CI: 1.20-7.20, P = 0.018; RVI score 2 vs. RVI score 0, HR: 3.20, 95% CI: 1.28-7.98, P = 0.013; RVI score 3 vs. RVI score 0, HR: 7.17, 95% CI: 2.65-19.38, P < 0.001), and had the best performance in model goodness of fit, discrimination and variance explained than the other RV indices. CONCLUSIONS: The RVI score was independently related to 30 day mortality and had the potential to grade the severity of RV dysfunction in septic patients.
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Zhang et al. (2023) conducted an observational in Sepsis and septic shock (n=327). Right ventricular injury (RVI) score vs. RVI score 0 was evaluated on 30-day mortality (HR 7.17, 95% CI 2.65-19.38, p=<0.001). A right ventricular injury score of 3 was independently associated with a significantly higher risk of 30-day mortality compared to a score of 0 (HR 7.17) in patients with sepsis.
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