Agarwal Raksheeth, Yakkali Shreyas, Shah Priyansh, Vyas Rhea, Kushwaha Ankit, Krishnan Ankita, Nair Anika Sasidharan, Hanumanthu Balaram Krishna Jagannayakulu, Faillace Robert T, Gashi Eleonora, Gulani Perminder
Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461, USA.
Department of Pulmonary and Critical Care Medicine, Jackson Madison County General Hospital, Jackson, TN 38305, USA.
J Clin Med. 2025 Aug 1;14(15):5423. doi: 10.3390/jcm14155423.
: Right ventricular (RV) dysfunction is associated with poor clinical outcomes in critically ill sepsis patients, but its pathophysiology and predictors are incompletely characterized. We aimed to investigate the predictors of RV dysfunction and its outcomes in sepsis patients admitted to the intensive care unit (ICU). : This is a single-center retrospective cohort study of adult patients admitted to the ICU for sepsis who had echocardiography within 72 h of diagnosis. Patients with acute coronary syndrome, acute decompensated heart failure, or significant valvular dysfunction were excluded. RV dysfunction was defined as the presence of RV dilation, hypokinesis, or both. Demographics and clinical outcomes were obtained from electronic medical records. : A total of 361 patients were included in our study-47 with and 314 without RV dysfunction. The mean age of the population was 66.8 years and 54.6% were females. Compared to those without RV dysfunction, patients with RV dysfunction were more likely to require mechanical ventilation (63.8% vs. 43.9%, = 0.01) and vasopressor support (61.7% vs. 36.6%, < 0.01). On multivariate logistic regression analysis, increasing age (OR 1.03, 95% C.I. 1.00-1.06), a history of HIV infection (OR 5.88, 95% C.I. 1.57-22.11) and atrial fibrillation (OR 4.34, 95% C.I. 1.83-10.29), and presence of LV systolic dysfunction (OR 14.40, 95% C.I. 5.63-36.84) were independently associated with RV dysfunction. Patients with RV dysfunction had significantly worse 30-day survival (Log-Rank = 0.023). On multivariate Cox regression analysis, older age (HR 1.02, 95% C.I. 1.00-1.04) and peak lactate (HR 1.16, 95% C.I. 1.11-1.21) were independent predictors of 30-day mortality. : Among other findings, our data suggests a possible association between a history of HIV infection and RV dysfunction in critically ill sepsis patients, and this should be investigated further in future studies. Patients with evidence of RV dysfunction had poorer survival in this population; however this was not an independent predictor of mortality in the multivariate analysis. A larger cohort with a longer follow-up period may provide further insights.
右心室（RV）功能障碍与重症脓毒症患者不良临床结局相关，但其病理生理学及预测因素尚未完全明确。我们旨在研究入住重症监护病房（ICU）的脓毒症患者右心室功能障碍的预测因素及其结局。
这是一项单中心回顾性队列研究，研究对象为因脓毒症入住ICU且在诊断后72小时内接受超声心动图检查的成年患者。排除患有急性冠状动脉综合征、急性失代偿性心力衰竭或严重瓣膜功能障碍的患者。右心室功能障碍定义为存在右心室扩张、运动减弱或两者皆有。人口统计学资料和临床结局从电子病历中获取。
我们的研究共纳入361例患者，其中47例存在右心室功能障碍，314例无右心室功能障碍。研究人群的平均年龄为66.8岁，女性占54.6%。与无右心室功能障碍的患者相比，有右心室功能障碍的患者更可能需要机械通气（63.8%对43.9%，P = 0.01）和血管活性药物支持（61.7%对36.6%，P < 0.01）。多因素逻辑回归分析显示，年龄增加（比值比[OR]1.03，95%置信区间[C.I.]1.00 - 1.06）、HIV感染史（OR 5.88，95% C.I. 1.57 - 22.11）、心房颤动（OR 4.34，95% C.I. 1.83 - 10.29）以及左心室收缩功能障碍的存在（OR 14.40，95% C.I. 5.63 - 36.84）与右心室功能障碍独立相关。有右心室功能障碍的患者30天生存率显著更低（对数秩检验P = 0.023）。多因素Cox回归分析显示，年龄较大（风险比[HR]1.02，95% C.I. 1.00 - 1.04）和血乳酸峰值（HR 1.16，95% C.I. 1.11 - 1.21）是30天死亡率的独立预测因素。
在其他研究结果中，我们的数据表明重症脓毒症患者HIV感染史与右心室功能障碍之间可能存在关联，这一点应在未来研究中进一步探究。在该人群中，有右心室功能障碍证据的患者生存率更低；然而，在多因素分析中这并非死亡率的独立预测因素。更大规模且随访期更长的队列研究可能会提供更多见解。
