Association Between Initial Left Ventricular Systolic Dysfunction and Clinical Outcome in Sepsis: A Multicenter Cohort Study

Abstract

Objectives: To investigate the association between the severities of left ventricular (LV) systolic dysfunction and clinical outcomes in patients with sepsis, with a particular focus on in-hospital mortality.

Design: Multicenter cohort study.

Setting: Nineteen tertiary or university-affiliated hospitals in South Korea.

Patients: A total of 2274 adult patients with sepsis or septic shock underwent echocardiographic examination within 24 hours of sepsis recognition.

Interventions: None.

Measurements and main results: Patients were stratified by left ventricular ejection fraction (LVEF) into three groups: normal (> 50%, n = 1803), mild-to-moderate dysfunction (30-50%, n = 356), and severe dysfunction (< 30%, n = 115). In-hospital mortality is significantly associated with LV dysfunction severity (normal: 25.73%, mild-to-moderate: 29.49%, severe: 40.00%; p = 0.023). After propensity score matching using three different methodologies, severe LV dysfunction remained independently associated with increased in-hospital mortality (adjusted odds ratio [OR] 1.81; 95% CI, 1.09-3.03). This effect was more pronounced in patients without preexisting cardiovascular disease (CVD) (OR 1.84; 95% CI, 1.08-3.13) and those with bacteremia (OR 2.20; 95% CI, 1.5-3.22). Cardiopulmonary arrest rates increased significantly with dysfunction severity (normal: 2.11%, mild-to-moderate: 3.93%, severe: 10.43%; p < 0.001), while other ICU complications showed no significant differences.

Conclusions: Severe LV systolic dysfunction (LVEF < 30%) is associated with significantly increased in-hospital mortality in sepsis patients, particularly in those with bacteremia and without preexisting CVD. These findings highlight the importance of early cardiac function assessment in sepsis and suggest that infection status and underlying cardiovascular health modify the relationship between LV dysfunction and clinical outcome.

Keywords: bacteremia; cardiomyopathy; ejection fraction; left ventricular dysfunction; mortality; sepsis.