Intensive Care Medicine

, Volume 41, Issue 6, pp 1004–1013 | Cite as

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

  • Filippo Sanfilippo
  • Carlos Corredor
  • Nick Fletcher
  • Giora Landesberg
  • Umberto Benedetto
  • Pierre Foex
  • Maurizio Cecconi
Systematic Review

Abstract

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.

Keywords

Systolic dysfunction Echocardiography Intensive care Tissue Doppler imaging Septic shock Severe sepsis 

Notes

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

134_2015_3748_MOESM1_ESM.pdf (183 kb)
Supplementary material 1 (PDF 183 kb)
134_2015_3748_MOESM2_ESM.docx (94 kb)
Supplementary material 2 (DOCX 93 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Filippo Sanfilippo
    • 1
  • Carlos Corredor
    • 1
  • Nick Fletcher
    • 1
  • Giora Landesberg
    • 2
  • Umberto Benedetto
    • 3
  • Pierre Foex
    • 4
  • Maurizio Cecconi
    • 5
  1. 1.Cardiothoracic Intensive Care UnitIntensive Care Directorate–St Georges Healthcare NHS TrustLondonUK
  2. 2.Department of Anesthesiology and Critical Care MedicineHadassah-Hebrew University Medical CenterJerusalemIsrael
  3. 3.Nuffield Department of Cardiac SurgeryJohn Radcliffe HospitalOxfordUK
  4. 4.Nuffield Department of AnaestheticsUniversity of Oxford–John Radcliffe HospitalOxfordUK
  5. 5.Anaesthesia and Critical Care St George’s Hospital and Medical SchoolLondonUK

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