title: Correlation of left ventricular systolic dysfunction determined by low ejection fraction and 30-day mortality in patients with severe sepsis and septic shock: a systematic review and meta-analysis.
abstract: BACKGROUND
  The prognostic implications of myocardial dysfunction in patients with sepsis and its association with mortality are controversial. Several tools have been proposed to evaluate cardiac function in these patients, but their usefulness beyond guiding therapy is unclear. We review the value of echocardiographic estimate of left ventricular ejection fraction (LVEF) in the setting of severe sepsis and/or septic shock and its correlation with 30-day mortality.
  
  
  METHODS
  We conducted a systematic review and meta-analysis to evaluate the prognostic functionality of newly diagnosed LV systolic dysfunction by transthoracic echocardiography on critical ill patients admitted to the intensive care unit with severe sepsis or septic shock.
  
  
  RESULTS
  A search of EMBASE and PubMed, Ovide MEDLINE, and Cochrane CENTRAL medical databases yielded 7 studies meeting inclusion criteria reporting on a total of 585 patients. The pooled sensitivity of depressed LVEF for mortality was 52% (95% confidence interval [CI], 29%-73%), and pooled specificity was 63% (95% CI, 53%-71%). Summary receiver operating characteristic curve showed an area under the curve of 0.62 (95% CI, 0.58-0.67). The overall mortality diagnostic odd ratio for septic patients with LV systolic dysfunction was 1.92 (95% CI, 1.27-2.899). Statistical heterogeneity of studies was moderate.
  
  
  CONCLUSIONS
  The presence of new LV systolic dysfunction associated with sepsis and defined as low LVEF is neither a sensitive nor a specific predictor of mortality. These findings are limited because of the heterogeneity and underpower of the studies. Further research into this method is warranted.
authors.affiliation: Department of Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Ronaldo A
authors.initials: RA
authors.lastname: Sevilla Berrios
authors.affiliation: Department of Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: John C
authors.initials: JC
authors.lastname: O'Horo
authors.affiliation: Department of Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Venu
authors.initials: V
authors.lastname: Velagapudi
authors.affiliation: Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic, Rochester MN. Electronic address: Pulido.juan@mayo.edu.
authors.forename: Juan N
authors.initials: JN
authors.lastname: Pulido
mesh_terms: D019540:Area Under Curve; D016001:Confidence Intervals; D004452:Echocardiography / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D011379:Prognosis; D012372:ROC Curve; D018805:Sepsis / Q000401:mortality / Q000503:physiopathology*; D012772:Shock, Septic / Q000401:mortality / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D016277:Ventricular Function, Left
keywords: Echocardiography; Mortality; Septic shock; Systolic dysfunction