Beyond APACHE II: the role of TAPSE in predicting mortality among septic patients and septic shock; a systematic review and metanalysis Right heart, right prognosis: TAPSE, a new tool for predicting mortality among septic patients and septic shock; a systematic review and metanalysis.

Abstract

Background: Bacterial infections are a serious global health problem, especially for older and critically ill patients, who are at increased risk of complications and mortality. Traditional tools like APACHE II and SOFA scores are widely used to predict outcomes in sepsis, but recent attention has focused on the right heart function-specifically, the tricuspid annular plane systolic excursion (TAPSE)-as a simple, bedside marker with potential prognostic value.

Objective: This systematic review and meta-analysis aimed to explore the prognostic value of TAPSE in patients with sepsis or septic shock, focusing on its predictive ability compared to established clinical indices such as APACHE II, SOFA and left ventricular ejection fraction (LVEF).

Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library and Web of Science up to April 2025. Studies assessing TAPSE in septic patients were included according to predefined criteria. Data on mortality, TAPSE, APACHE II, SOFA and LVEF were extracted and analyzed. Study quality was assessed using the Newcastle-Ottawa Scale.

Results: Ten studies with a total of 1812 patients have been included. The analysis revealed that lower TAPSE values were significantly associated with higher mortality (mean difference -0.50 cm; 95% CI: -0.57 to -0.43; p < 0.00001). Similarly, APACHE II scores were higher in non-survivors (mean difference 4.62; 95% CI: 3.17 to 6.07; p < 0.00001). In contrast, LVEF showed no significant correlation with mortality (mean difference -1.46; p = 0.20). Despite variability among studies, the prognostic value of TAPSE remained consistently evident.

Conclusions: TAPSE emerges as a practical, non-invasive tool for assessing right ventricular function and predicting mortality in patients with sepsis. Its simplicity and bedside availability make it a valuable complement to traditional severity scores like APACHE II. Unlike LVEF, which appears less informative in this setting, TAPSE could enhance early risk stratification and guide clinical decision-making, particularly in vulnerable populations such as the elderly and critically ill.