J Cardiothorac Surg. 2026 May 14. doi: 10.1186/s13019-026-04094-w. Online ahead of print.
ABSTRACT
BACKGROUND: Sepsis is a critical condition that leads to significant morbidity and mortality. Accurate prediction of patient outcomes is essential for effective management. This meta-analysis evaluates the prognostic value of echocardiographic cardiac function parameters, particularly left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (LVGLS), in predicting short-term outcomes in sepsis patients.
METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted from inception to January 19, 2026, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort studies assessing echocardiographic parameters and short-term mortality in adult sepsis were included. Random-effects meta-analysis was performed using standardized mean differences (SMDs). Sensitivity analyses included leave-one-out procedures and restricted maximum likelihood with Hartung-Knapp adjustment. Publication bias was evaluated using funnel plots and Egger’s regression test.
RESULTS: Nine cohort studies published between 2014 and 2021 were included. LVGLS was significantly more impaired in non-survivors than in survivors (SMD – 0.40, 95% confidence interval [CI] – 0.62 to – 0.18; I² = 51.1%). Results remained robust with Hartung-Knapp adjustment (SMD – 0.55, 95% CI – 0.79 to – 0.30). In a septic shock-only sensitivity analysis, the association persisted (SMD – 0.76, 95% CI – 1.01 to – 0.51; I² = 0%). Subgroup analysis showed no significant difference between Sepsis-2 and Sepsis-3 studies (P = 0.45). LVEF was not associated with short-term mortality (SMD 0.06, 95% CI – 0.08 to 0.20; I² = 27.2%). Funnel plot inspection showed no clear asymmetry, and Egger’s test was not statistically significant.
CONCLUSIONS: LVGLS is associated with short-term mortality in sepsis and may provide incremental prognostic information beyond conventional LVEF assessment. Prospective studies are needed to define clinically meaningful thresholds and evaluate incremental value over established risk scores.
PMID:42135714 | DOI:10.1186/s13019-026-04094-w
