Right Ventricular Dysfunction Score in the Prognostic Evaluation of Patients with Sepsis and Septic Shock.

Abstract

Background and aims: Right ventricular dysfunction (RVD) in sepsis carries a poor prognosis, and there is heterogeneity in its assessment methods. The RVD score, incorporating multiple domains of RV function, was originally designed for chronic heart failure grading. This study evaluated its ability to predict 28-day all-cause mortality in sepsis and septic shock.

Patients and methods: In this prospective observational cohort, 211 adults with septic shock were enrolled within 48 hours of diagnosis. The RVD score was calculated using five transthoracic echocardiographic parameters: Pulmonary artery (PA) systolic pressure (PASP), RV end-diastolic area/body surface area (RVEDA/BSA), tricuspid annular plane systolic excursion (TAPSE), tricuspid regurgitation (TR) grade, and inferior vena cava (IVC) collapsibility. One point was assigned to each component if the measurements deviated from predefined cut-offs. Tricuspid annular plane systolic excursion/PASP ratio, a marker of RV-PA coupling, was also computed. Patients were followed for 28-day prognostic outcomes.

Results: Among 189 analyzed patients, 39.68% were nonsurvivors. An RVD score of >2 and a TAPSE/PASP ratio of ≤0.447 mm/mm Hg predicted 28-day mortality with an area under receiving operating characteristic curve (AUROC) of 0.857 [95% confidence interval (CI): 0.801-0.914] and an AUROC of 0.883 (95% CI: 0.829-0.937), respectively. Their performance did not significantly differ (ΔAUROC = 0.026, p = 0.09). In a multivariable logistic regression model, after adjustment for key clinical covariates, RVD score of >2 [adjusted odds ratio (OR): 3.48, 95% CI: 1.37-8.83] remained an independent predictor of mortality.

Conclusion: Right ventricular dysfunction score of >2, as a composite marker of RVD, demonstrates a robust prognostic utility in sepsis and septic shock. Tricuspid annular plane systolic excursion/PASP of ≤0.447 is a simpler alternative, given its comparable predictive performance for 28-day mortality.

Clinical significance: Right ventricular dysfunction score of >2 and TAPSE/PASP of ≤0.447, being prognostic echocardiographic parameters, can be used to indicate the timing of incorporation of various RV-protective measures during the course of management of septic shock.

How to cite this article: Kasinathan S, Maitra S, Khanna P, Anand RK, Ekka M, Ray BR. Right Ventricular Dysfunction Score in the Prognostic Evaluation of Patients with Sepsis and Septic Shock. Indian J Crit Care Med 2026;30(5):389-397.