Time Course of Morbidity and Mortality Across Echocardiographic Phenotypes in Patients With Sepsis: A Systematic Review and Meta-Analysis

OBJECTIVES: To determine the temporal evolution of morbidity and mortality across different echocardiographic phenotypes of new-onset myocardial dysfunction in patients with sepsis. DATA SOURCES: PubMed, Embase, Web of Science, MEDLINE, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to October 1, 2024. STUDY SELECTION: All original studies related to new-onset myocardial dysfunction diagnosed by echocardiography in adult patients with sepsis were included. DATA EXTRACTION: Data were collected according to the predefined outcomes. DATA SYNTHESIS: This systematic review included 65 studies from 18 regions, involving 17,008 patients with sepsis. The meta-analysis encompassed three echocardiographic phenotypes, namely left ventricular systolic dysfunction (LVSD), left ventricular diastolic dysfunction (LVDD), and right ventricular dysfunction (RVD), as well as four subgroups based on different echocardiographic time points. No patients had cardiac dysfunction at baseline, and the occurrence rate of heart dysfunction declined to a minimal level during the recovery phase. The occurrence rate of LVSD peaked at 33% (95% CI, 27-40%) within 48 hours and declined to 22% (95% CI, 18-25%) within 72 hours. The occurrence rate of LVDD rose to 46% (95% CI, 34-57%) within 48 hours and dropped to 44% (95% CI, 32-56%) within 72 hours. The occurrence rate of RVD peaked at 47% (95% CI, 37-58%) within 48 hours and decreased to 33% (95% CI, 3-75%) within 72 hours. Patients with LVSD, LVDD, or RVD showed a higher risk of death (LVSD: relative risk [RR], 1.57 [95% CI, 1.29-1.91], p < 0.0001; LVDD: RR, 1.36 [95% CI, 1.05-1.75], p = 0.02; and RVD: RR, 1.62 [95% CI, 1.35-1.95], p < 0.0001). CONCLUSIONS: This meta-analysis shows a parabolic-like pattern of the occurrence rate of echocardiographic phenotypes (LVSD, LVDD, and RVD) over the time course of sepsis. LVSD, LVDD, and RVD are significant risk factors for mortality in sepsis.