[Association between right ventricular function and short-term death risk in patients with sepsis].

OBJECTIVE: To evaluate the right ventricular function in patients with sepsis and to analyze the association between right ventricular dysfunction and 30-day mortality.

METHODS: A retrospective cohort study was conducted. The clinical data from 196 adult patients with sepsis admitted to the department of critical care medicine of the Affiliated People's Hospital of Jiangsu University from January 2020 to December 2023 were collected, including age, gender, mean arterial pressure (MAP), oxygenation index (PaO2/FiO2), heart rate (HR), urine output, continuous renal replacement therapy (CRRT), presence of acute renal failure, Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, Elixhauser comorbidity index (ECI) score, blood lactic acid (Lac), fluid resuscitation volume, vasoactive drug dose, mechanical ventilation status, echocardiographic parameters within 24 hours after admission, and 30-day outcomes. Demographic, clinical, and echocardiographic features were compared between survivors and non-survivors. The prevalence and death risk of ventricular dysfunction subtypes in patients with sepsis were analyzed. Multivariate Logistic regression analysis was used to identify independent risk factors for short-term death risk.

RESULTS: Among 196 patients with sepsis, 157 survived for 30 days and 39 died. Compared with the survival group, the patients in the non-survival group had less urine output, a higher proportion of patients receiving CRRT, higher APACHE II score, higher Lac, higher doses of vasoactive drugs, and a higher proportion of requiring mechanical ventilation. Echocardiography showed that the patients in the non-survival group had lower tricuspid annular peak systolic excursion (TAPSE), right ventricular fractional area change, and left ventricular ejection fraction (LVEF) as compared with those in the survival group [TAPSE (mm): 16.0±3.6 vs. 19.3±4.4, right ventricular fractional area change: (30.23±8.14)% vs. (33.69±7.81)%, LVEF: 0.575±0.129 vs. 0.637±0.069, all P<0.05], and higher right ventricular end-systolic area and ratio of left ventricular early diastolic mitral flow velocity to mitral annular motion velocity [E/E'; right ventricular end-systolic area (cm2): 15.75±4.45 vs. 14.27±3.39, left ventricular E/E' ratio: 9.18±4.43 vs. 7.74±3.12, both P<0.05]. Among 196 patients with sepsis, 136 patients (69.4%) developed ventricular dysfunction, including isolated right ventricular dysfunction in 50 (25.5%), isolated left ventricular systolic dysfunction in 33 (16.8%), isolated left ventricular diastolic dysfunction in 7 (3.6%), combined left ventricular systolic dysfunction and right ventricular dysfunction in 25 (12.8%), combined right ventricular dysfunction and left ventricular diastolic dysfunction in 1 (0.5%), and combined left ventricular systolic dysfunction, left ventricular diastolic dysfunction, and right ventricular dysfunction in 20 (10.2%). The 30-day mortality was highest in patients with isolated right ventricular dysfunction [36.0% (18/50)], followed by those with biventricular dysfunction [30.4% (14/46)] and isolated left ventricular dysfunction [22.5% (9/40)], and lowest in patients without ventricular dysfunction [13.8% (8/60)], with statistically significant difference (P<0.05). Among 196 patients with sepsis, right ventricular dysfunction occurred in nearly half of all patients [96 cases (49.0%)]. Compared with those without right ventricular dysfunction, the patients with right ventricular dysfunction had higher incidence of acute renal failure, higher APACHE II score, higher Lac, higher fluid resuscitation volume, higher vasoactive drug dose, higher ratio of requiring mechanical ventilation, and higher 30-day mortality [incidence of acute renal failure: 63.5% (61/96) vs. 48.0% (48/100), APACHE II score: 13 (1, 41) vs. 7 (1, 34), Lac (mmol/L): 7.8±3.4 vs. 4.2±2.3, fluid resuscitation volume (mL): 2 032±225 vs. 1 123±115, vasoactive drug dose (μg×kg-1×min-1): 1.1 (0.2, 2.1) vs. 0.7 (0.2, 2.0), ratio of requiring mechanical ventilation: 18.8% (18/96) vs. 15.0% (15/100), 30-day mortality: 40.6% (39/96) vs. 21.0% (21/100), all P<0.05]. Multivariate Logistic regression analysis identified CRRT [odds ratio (OR)=2.43, 95% confidence interval (95%CI) was 0.25-0.64], higher APACHE II score (OR=1.35, 95%CI was 1.21-1.65), higher Lac (OR=13.44, 95%CI was 6.15-25.35), higher vasoactive drug dose (OR=65.45, 95%CI was 19.88-195.83), mechanical ventilation (OR=92.45, 95%CI was 34.67-369.45), right ventricular dysfunction (OR=2.34, 95%CI was 1.21-3.78), and left ventricular diastolic dysfunction (OR=2.35, 95%CI was 1.09-5.18) as independent risk factors of 30-day death in patients with sepsis (all P<0.05).

CONCLUSIONS: Right ventricular dysfunction is common in patients with early sepsis and serves as an independent risk factor for 30-day death.