The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

Ryota Sato, Siddharth Dugar, Wisit Cheungpasitporn, Mary Schleicher, Patrick Collier, Saraschandra Vallabhajosyula, Abhijit Duggal, Ryota Sato, Siddharth Dugar, Wisit Cheungpasitporn, Mary Schleicher, Patrick Collier, Saraschandra Vallabhajosyula, Abhijit Duggal

Abstract

Background: Previous studies have found various incidences of right ventricular (RV) injury and its association with clinical outcome in patients with acute respiratory distress syndrome (ARDS). In this systematic review and meta-analysis, we aimed to investigate the impact of the presence of RV injury on mortality in patients with ARDS.

Method: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies investigating the association between RV injury and mortality. Two authors independently evaluated whether studies meet eligibility criteria and extracted the selected patients' and studies' characteristics and outcomes. RV injury was diagnosed by trans-thoracic echocardiogram (TTE), trans-esophageal echocardiogram (TEE) and PAC (pulmonary artery catheter) in the included studies. The primary outcome was the association between mortality and the presence of RV injury in patients with ARDS. The overall reported mortality was defined as either the intensive care unit (ICU) mortality, in-hospital mortality, or mortality within 90 days, and short-term mortality was defined as ICU-mortality, in-hospital mortality, or mortality within 30 days.

Results: We included 9 studies (N = 1861 patients) in this meta-analysis. RV injury that included RV dysfunction, RV dysfunction with hemodynamic compromise, RV failure, or acute cor-pulmonale was present in 21.0% (391/1,861). In the pooled meta-analysis, the presence of RV injury in patients with ARDS was associated with significantly higher overall mortality (OR 1.45, 95% CI 1.13-1.86, p-value = 0.003, I2 = 0%), as well as short-term mortality (OR 1.48, 95% CI 1.14-1.93, p-value = 0.003, I2 = 0%).

Conclusion: In this systematic review and meta-analysis including 1861 patients with ARDS, the presence of RV injury was significantly associated with increased overall and short-term mortality.

Trial registration: The protocol was registered at PROSPERO (CRD42020206521).

Keywords: Acute cor pulmonale; Acute lung injury; Acute respiratory distress syndrome; Right ventricular dysfunction.

Conflict of interest statement

We declare no competing interests.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) chart. Identification and selection of studies for inclusion
Fig. 2
Fig. 2
Forest plot of patients with right ventricular injury versus those without: the pooled odds ratios of ICU-mortality, 28-day mortality, In-hospital mortality, 60-day mortality, and overall mortality

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