Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis

• Published in: Intensive care medicine Vol. 41; no. 6; pp. 1004 - 1013
• Main Authors: Sanfilippo, Filippo, Corredor, Carlos, Fletcher, Nick, Landesberg, Giora, Benedetto, Umberto, Foex, Pierre, Cecconi, Maurizio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2015; Springer; Springer Nature B.V
• Subjects: Anesthesiology; Critical care; Critical Care Medicine; Diastole - physiology; Doppler effect; Emergency Medicine; Heart Failure, Diastolic - mortality; Heart Failure, Diastolic - physiopathology; Hemodynamics; Hospitals; Humans; Infection; Intensive; Intensive care; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Meta-analysis; Mortality; Pain Medicine; Patient outcomes; Pediatrics; Pneumology/Respiratory System; Sepsis; Sepsis - mortality; Sepsis - physiopathology; Systematic Review; United Kingdom; United Kingdom; United Kingdom > UK; Septic shock; Intensive care; Echocardiography; Tissue Doppler imaging; Severe sepsis; Systolic dysfunction
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-015-3748-7

Background Myocardial dysfunction may contribute to the haemodynamic instability which accompanies sepsis, and may result in circulatory failure. There is no association between systolic dysfunction (SD) and mortality in septic patients and there is conflicting evidence regarding the effects of diastolic dysfunction (DD) on mortality in septic patients. Methods We conducted a systematic review and meta-analysis to investigate DD and mortality in septic patients. We included studies conducted in this patient population which investigated the association between DD reported according to tissue Doppler imaging (TDI) criteria and mortality, using the longest reported follow-up. As a secondary endpoint, we evaluated the association between SD and mortality according to the results reported by the retrieved studies. Results We included seven studies in our meta-analysis with 636 septic patients, 48 % of them were found to have DD. We found a significant association between DD and mortality (RR 1.82, 95 % CI 1.12–2.97, p  = 0.02). This finding remained valid in a further analysis which including an older study reporting DD without TDI criteria. Five studies reported data on SD for a total of 581 patients, 29.6 % of them with SD. No association was found between SD and mortality (RR 0.93, 95 % CI 0.62–1.39, p  = 0.73). Looking at subgroups, there was a trend towards higher mortality comparing isolated DD or combined SD–DD vs normal heart function ( p  = 0.10 and p  = 0.05, respectively). Conclusions Diastolic dysfunction is common in septic patients and it is associated with mortality. Systolic dysfunction is less common and is not associated with mortality in this group of patients.