Key result
RV dysfunction in sepsis is linked to ~298% higher 28-day mortality.
Why the study?
The precise relationship between right ventricular dysfunction and mortality in patients with sepsis remains poorly understood.
Does right ventricular dysfunction predict 28-day mortality in patients presenting with sepsis or septic shock in the emergency department?
Observational (n=75)
No
Does right ventricular dysfunction predict 28-day mortality in patients presenting with sepsis or septic shock in the emergency department?
Odds Ratio: 3.98 (95% CI 1.3–11.9)
Absolute Event Rate: 68% vs 34%
p-value: p=0.013
Right ventricular dysfunction, present in nearly one-third of ED patients with sepsis or septic shock, is associated with a fourfold higher 28-day mortality.
May warrant RV assessment in ED sepsis prognostication; leaves open whether targeted support improves survival.
Aim: Sepsis and septic shock present a significant challenge in the emergency department (ED) owing to their high mortality rates.The presence of right ventricle (RV) dysfunction during sepsis could potentially exacerbate unfavorable outcomes.However, the precise relationship between RV dysfunction and mortality in septic patients remains poorly understood.Therefore, this study aims to investigate the prognostic value of RV dysfunction as a predictor of mortality in patients presenting with sepsis or septic shock in the ED of Alexandria main university hospital.Material and Methods: A prospective observational study was performed on 75 patients who presented to the ED with sepsis or septic shock.Echocardiographic parameters, including the tricuspid annulus systolic plane excursion (TAPSE) and the fractional area change, were measured within 24 hours after admission for assessment of RV dysfunction; then, patients were evaluated according to sequential organ failure score (SOFA) and acute physiologic and chronic health assessment (APACHE).Using multivariate regression, the current study assessed the relationship between 28-day mortality and the presence of RV dysfunction, SOFA, and APACHE.Results: There were 75 patients in the study.22 patients (29%) had RV dysfunction.When compared to patients without RV dysfunction, those with RV dysfunction had a greater mortality rate (68% vs. 34%, p<0.001).RV dysfunction was shown to be associated with mortality in univariate regression analysis (OR:4.16,CI:1.44-12,P<0.008), and multivariable regression analysis revealed a high correlation between RV dysfunction and mortality (OR:3.98,CI:1.3-11.9,P<0.013).With a statistically significant area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value of 0.64, 45.5, 83.8, 68.2, and 66%, respectively, the receiver operator curve (ROC) indicated that RV dysfunction was linked to a considerable mortality rate.Discussion: RV dysfunction was found in nearly one-third of the studied patients with sepsis and is associated with fourfold higher 28-day mortality.
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Beshara et al. (2024) conducted an observational in Sepsis or septic shock (n=75). Right ventricular dysfunction vs. No right ventricular dysfunction was evaluated on 28-day mortality (OR 3.98, 95% CI 1.3-11.9, p=0.013). Right ventricular dysfunction was present in 29% of patients with sepsis or septic shock and was independently associated with a nearly fourfold increase in 28-day mortality (OR 3.98).
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