Jie Wang, Zewen Tong, Xiaoting Wang, Guangjian Wang
{"title":"脓毒症患者超声心动图表型中发病率和死亡率的时间进程：系统回顾和荟萃分析。","authors":"Jie Wang, Zewen Tong, Xiaoting Wang, Guangjian Wang","doi":"10.1097/CCM.0000000000006844","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To determine the temporal evolution of morbidity and mortality across different echocardiographic phenotypes of new-onset myocardial dysfunction in patients with sepsis.</p><p><strong>Data sources: </strong>PubMed, Embase, Web of Science, MEDLINE, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to October 1, 2024.</p><p><strong>Study selection: </strong>All original studies related to new-onset myocardial dysfunction diagnosed by echocardiography in adult patients with sepsis were included.</p><p><strong>Data extraction: </strong>Data were collected according to the predefined outcomes.</p><p><strong>Data synthesis: </strong>This systematic review included 65 studies from 18 regions, involving 17,008 patients with sepsis. The meta-analysis encompassed three echocardiographic phenotypes, namely left ventricular systolic dysfunction (LVSD), left ventricular diastolic dysfunction (LVDD), and right ventricular dysfunction (RVD), as well as four subgroups based on different echocardiographic time points. No patients had cardiac dysfunction at baseline, and the occurrence rate of heart dysfunction declined to a minimal level during the recovery phase. The occurrence rate of LVSD peaked at 33% (95% CI, 27-40%) within 48 hours and declined to 22% (95% CI, 18-25%) within 72 hours. The occurrence rate of LVDD rose to 46% (95% CI, 34-57%) within 48 hours and dropped to 44% (95% CI, 32-56%) within 72 hours. The occurrence rate of RVD peaked at 47% (95% CI, 37-58%) within 48 hours and decreased to 33% (95% CI, 3-75%) within 72 hours. Patients with LVSD, LVDD, or RVD showed a higher risk of death (LVSD: relative risk [RR], 1.57 [95% CI, 1.29-1.91], p < 0.0001; LVDD: RR, 1.36 [95% CI, 1.05-1.75], p = 0.02; and RVD: RR, 1.62 [95% CI, 1.35-1.95], p < 0.0001).</p><p><strong>Conclusions: </strong>This meta-analysis shows a parabolic-like pattern of the occurrence rate of echocardiographic phenotypes (LVSD, LVDD, and RVD) over the time course of sepsis. LVSD, LVDD, and RVD are significant risk factors for mortality in sepsis.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Time Course of Morbidity and Mortality Across Echocardiographic Phenotypes in Patients With Sepsis: A Systematic Review and Meta-Analysis.\",\"authors\":\"Jie Wang, Zewen Tong, Xiaoting Wang, Guangjian Wang\",\"doi\":\"10.1097/CCM.0000000000006844\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To determine the temporal evolution of morbidity and mortality across different echocardiographic phenotypes of new-onset myocardial dysfunction in patients with sepsis.</p><p><strong>Data sources: </strong>PubMed, Embase, Web of Science, MEDLINE, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to October 1, 2024.</p><p><strong>Study selection: </strong>All original studies related to new-onset myocardial dysfunction diagnosed by echocardiography in adult patients with sepsis were included.</p><p><strong>Data extraction: </strong>Data were collected according to the predefined outcomes.</p><p><strong>Data synthesis: </strong>This systematic review included 65 studies from 18 regions, involving 17,008 patients with sepsis. The meta-analysis encompassed three echocardiographic phenotypes, namely left ventricular systolic dysfunction (LVSD), left ventricular diastolic dysfunction (LVDD), and right ventricular dysfunction (RVD), as well as four subgroups based on different echocardiographic time points. No patients had cardiac dysfunction at baseline, and the occurrence rate of heart dysfunction declined to a minimal level during the recovery phase. The occurrence rate of LVSD peaked at 33% (95% CI, 27-40%) within 48 hours and declined to 22% (95% CI, 18-25%) within 72 hours. The occurrence rate of LVDD rose to 46% (95% CI, 34-57%) within 48 hours and dropped to 44% (95% CI, 32-56%) within 72 hours. The occurrence rate of RVD peaked at 47% (95% CI, 37-58%) within 48 hours and decreased to 33% (95% CI, 3-75%) within 72 hours. Patients with LVSD, LVDD, or RVD showed a higher risk of death (LVSD: relative risk [RR], 1.57 [95% CI, 1.29-1.91], p < 0.0001; LVDD: RR, 1.36 [95% CI, 1.05-1.75], p = 0.02; and RVD: RR, 1.62 [95% CI, 1.35-1.95], p < 0.0001).</p><p><strong>Conclusions: </strong>This meta-analysis shows a parabolic-like pattern of the occurrence rate of echocardiographic phenotypes (LVSD, LVDD, and RVD) over the time course of sepsis. 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引用次数: 0
摘要
目的：确定脓毒症患者新发心肌功能障碍不同超声心动图表型的发病率和死亡率的时间演变。数据来源：PubMed， Embase, Web of Science， MEDLINE, Cochrane Central Register of Controlled Trials，谷歌Scholar检索截止至2024年10月1日。研究选择：纳入所有与成人败血症患者超声心动图诊断的新发心肌功能障碍相关的原始研究。数据提取：根据预先设定的结果收集数据。数据综合：本系统综述包括来自18个地区的65项研究，涉及17008例败血症患者。荟萃分析包括三种超声心动图表型，即左室收缩功能障碍（LVSD）、左室舒张功能障碍（LVDD）和右室功能障碍（RVD），以及基于不同超声心动图时间点的四个亚组。基线时无心功能障碍，恢复期心功能障碍发生率降至最低。48小时内LVSD发生率最高为33% (95% CI, 27-40%)， 72小时内下降至22% （95% CI, 18-25%）。48小时内LVDD发生率上升至46% (95% CI, 34-57%)， 72小时内下降至44% （95% CI, 32-56%）。RVD的发生率在48小时内最高为47% (95% CI, 37-58%)，在72小时内下降至33% （95% CI, 3-75%）。LVSD、LVDD或RVD患者的死亡风险较高（LVSD：相对风险[RR]， 1.57 [95% CI, 1.29-1.91], p < 0.0001; LVDD: RR, 1.36 [95% CI, 1.05-1.75], p = 0.02; RVD: RR, 1.62 [95% CI, 1.35-1.95], p < 0.0001）。结论：该荟萃分析显示超声心动图表型（LVSD、LVDD和RVD）在脓毒症病程中的发生率呈抛物线状。LVSD、LVDD和RVD是脓毒症死亡的重要危险因素。
Time Course of Morbidity and Mortality Across Echocardiographic Phenotypes in Patients With Sepsis: A Systematic Review and Meta-Analysis.
Objectives: To determine the temporal evolution of morbidity and mortality across different echocardiographic phenotypes of new-onset myocardial dysfunction in patients with sepsis.
Data sources: PubMed, Embase, Web of Science, MEDLINE, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to October 1, 2024.
Study selection: All original studies related to new-onset myocardial dysfunction diagnosed by echocardiography in adult patients with sepsis were included.
Data extraction: Data were collected according to the predefined outcomes.
Data synthesis: This systematic review included 65 studies from 18 regions, involving 17,008 patients with sepsis. The meta-analysis encompassed three echocardiographic phenotypes, namely left ventricular systolic dysfunction (LVSD), left ventricular diastolic dysfunction (LVDD), and right ventricular dysfunction (RVD), as well as four subgroups based on different echocardiographic time points. No patients had cardiac dysfunction at baseline, and the occurrence rate of heart dysfunction declined to a minimal level during the recovery phase. The occurrence rate of LVSD peaked at 33% (95% CI, 27-40%) within 48 hours and declined to 22% (95% CI, 18-25%) within 72 hours. The occurrence rate of LVDD rose to 46% (95% CI, 34-57%) within 48 hours and dropped to 44% (95% CI, 32-56%) within 72 hours. The occurrence rate of RVD peaked at 47% (95% CI, 37-58%) within 48 hours and decreased to 33% (95% CI, 3-75%) within 72 hours. Patients with LVSD, LVDD, or RVD showed a higher risk of death (LVSD: relative risk [RR], 1.57 [95% CI, 1.29-1.91], p < 0.0001; LVDD: RR, 1.36 [95% CI, 1.05-1.75], p = 0.02; and RVD: RR, 1.62 [95% CI, 1.35-1.95], p < 0.0001).
Conclusions: This meta-analysis shows a parabolic-like pattern of the occurrence rate of echocardiographic phenotypes (LVSD, LVDD, and RVD) over the time course of sepsis. LVSD, LVDD, and RVD are significant risk factors for mortality in sepsis.
期刊介绍：
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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