Abstract：
BACKGROUND: Septic cardiomyopathy is associated with poor outcomes but its definition remains unclear. In a previous meta-analysis, left ventricular (LV) longitudinal strain (LS) showed significant prognostic value in septic patients, but findings were not robust due to a limited number of studies, differences in effect size and no adjustment for confounders.
METHODS: We conducted an updated systematic review (PubMed and Scopus up to 14.02.2023) and meta-analysis to investigate the association between LS and survival in septic patients. We included studies reporting global (from three apical views) or regional LS (one or two apical windows). A secondary analysis evaluated the association between LV ejection fraction (EF) and survival using data from the selected studies.
RESULTS: We included fourteen studies (1678 patients, survival 69.6%) and demonstrated an association between better performance (more negative LS) and survival with a mean difference (MD) of -1.45%[-2.10, -0.80] (p < 0.0001;I2 = 42%). No subgroup differences were found stratifying studies according to number of views used to calculate LS (p = 0.31;I2 = 16%), severity of sepsis (p = 0.42;I2 = 0%), and sepsis criteria (p = 0.59;I2 = 0%). Trial sequential analysis and sensitivity analyses confirmed the primary findings. Grade of evidence was low. In the included studies, thirteen reported LVEF and we found an association between higher LVEF and survival (MD = 2.44% [0.44,4.45]; p = 0.02;I2 = 42%).
CONCLUSIONS: We confirmed that more negative LS values are associated with higher survival in septic patients. The clinical relevance of this difference and whether the use of LS may improve understanding of septic cardiomyopathy and prognostication deserve further investigation. The association found between LVEF and survival is of unlikely clinical meaning.
BACKGROUND: PROSPERO number CRD42023432354.
METHODS: We conducted an updated systematic review (PubMed and Scopus up to 14.02.2023) and meta-analysis to investigate the association between LS and survival in septic patients. We included studies reporting global (from three apical views) or regional LS (one or two apical windows). A secondary analysis evaluated the association between LV ejection fraction (EF) and survival using data from the selected studies.
RESULTS: We included fourteen studies (1678 patients, survival 69.6%) and demonstrated an association between better performance (more negative LS) and survival with a mean difference (MD) of -1.45%[-2.10, -0.80] (p < 0.0001;I2 = 42%). No subgroup differences were found stratifying studies according to number of views used to calculate LS (p = 0.31;I2 = 16%), severity of sepsis (p = 0.42;I2 = 0%), and sepsis criteria (p = 0.59;I2 = 0%). Trial sequential analysis and sensitivity analyses confirmed the primary findings. Grade of evidence was low. In the included studies, thirteen reported LVEF and we found an association between higher LVEF and survival (MD = 2.44% [0.44,4.45]; p = 0.02;I2 = 42%).
CONCLUSIONS: We confirmed that more negative LS values are associated with higher survival in septic patients. The clinical relevance of this difference and whether the use of LS may improve understanding of septic cardiomyopathy and prognostication deserve further investigation. The association found between LVEF and survival is of unlikely clinical meaning.
BACKGROUND: PROSPERO number CRD42023432354.
摘要：
背景：化脓性心肌病与不良预后相关，但其定义尚不清楚。在之前的荟萃分析中，左心室（LV）纵向应变（LS）在脓毒症患者中显示出显着的预后价值，但是由于研究数量有限，研究结果并不可靠，效应大小的差异，对混杂因素没有调整。
方法：我们进行了更新的系统评价（PubMed和Scopus高达14.02.2023）和荟萃分析，以调查LS与脓毒症患者生存率之间的关联。我们纳入了报告全球（从三个根尖视图）或区域LS（一个或两个根尖窗口）的研究。二次分析使用来自所选研究的数据评估了LV射血分数(EF)与存活之间的关联。
结果：我们纳入了14项研究（1678例患者，生存率69.6％），并证明了更好的表现（阴性LS）与生存率之间的关联，平均差异（MD）为-1.45％[-2.10，-0.80]（p<0.0001；I2=42％）。根据用于计算LS的视图数量，分层研究没有发现亚组差异(p=0.31;I2=16%)，脓毒症的严重程度（p=0.42；I2=0%），和脓毒症标准（p=0.59；I2=0%）。试验序贯分析和敏感性分析证实了主要发现。证据等级很低。在纳入的研究中，13例报告了LVEF，我们发现较高的LVEF与生存率之间存在关联（MD=2.44％[0.44,4.45]；p=0.02；I2=42％）。
结论：我们证实，在脓毒症患者中，较多的阴性LS值与较高的生存率相关。这种差异的临床相关性以及使用LS是否可以提高对化脓性心肌病和预后的了解，值得进一步研究。LVEF与生存率之间的关联不太可能具有临床意义。
背景：PROSPERO编号CRD42023432354。
方法：我们进行了更新的系统评价（PubMed和Scopus高达14.02.2023）和荟萃分析，以调查LS与脓毒症患者生存率之间的关联。我们纳入了报告全球（从三个根尖视图）或区域LS（一个或两个根尖窗口）的研究。二次分析使用来自所选研究的数据评估了LV射血分数(EF)与存活之间的关联。
结果：我们纳入了14项研究（1678例患者，生存率69.6％），并证明了更好的表现（阴性LS）与生存率之间的关联，平均差异（MD）为-1.45％[-2.10，-0.80]（p<0.0001；I2=42％）。根据用于计算LS的视图数量，分层研究没有发现亚组差异(p=0.31;I2=16%)，脓毒症的严重程度（p=0.42；I2=0%），和脓毒症标准（p=0.59；I2=0%）。试验序贯分析和敏感性分析证实了主要发现。证据等级很低。在纳入的研究中，13例报告了LVEF，我们发现较高的LVEF与生存率之间存在关联（MD=2.44％[0.44,4.45]；p=0.02；I2=42％）。
结论：我们证实，在脓毒症患者中，较多的阴性LS值与较高的生存率相关。这种差异的临床相关性以及使用LS是否可以提高对化脓性心肌病和预后的了解，值得进一步研究。LVEF与生存率之间的关联不太可能具有临床意义。
背景：PROSPERO编号CRD42023432354。
