Impact of heart failure on outcomes in patients with sepsis: A systematic review and meta-analysis

Table 1 Characteristics of the studies and quality assessment

Ref.	Year	Setting	Study design	Sepsis severity	Diagnosis of HF	Outcomes	ORs	NOS score (S C O)
Grozdanovski et al[19]	2012	Single-centre, ICU, Republic of Macedonia	Prospective	Severe sepsis/septic shock	Confirmed by medical record	Hospital mortality	Adjusted	4 1 2
cui et al[9]	2014	Single-centre, ICU, China	Retros-pective	Severe sepsis/septic shock	Confirmed by medical record	Hospital mortality	Unadjusted	3 1 2
Lemay et al[4]	2014	Multicenter, database about medicare hospital, United States	Prospective	Severe sepsis	Confirmed by database of the Department of Veterans’ Affairs Health Care systems	Long-term mortality	Adjusted	4 2 3
Mourad et al[20]	2014	Single-centre, ICU, France	Prospective	Septic shock	Selection with diastolic dysfunction by echocardiography and medical record	Hospital mortality	Adjusted	4 2 2
Vallabhajosyula et al[12]	2017	Single-centre, ICU, United States	Retros-pective	Severe sepsis/septic shock	Selection with ventricular dysfunction by echocardiography and medical record	1-year mortality	Adjusted	4 2 3
Abu-Kaf et al[21]	2018	Single-centre, ICU databases, Israel	Retros-pective	Severe sepsis	Confirmed by medical record in ISR-SEPSIS	2-year mortality	Unadjusted	4 2 2
Arnautovic et al[6]	2018	Multicenter, ICU, United States	Retros-pective	Septic shock	Confirmed by medical record	Hospital mortality	Adjusted	4 2 2
Schuler et al[11]	2018	Multicenter, medicare hospital, United States	Retros-pective	Sepsis	Assessment of cardiac failure with SOFA score	long-term mortality	Adjusted	4 2 3
Kim et al[22]	2020	Single-centre, medicare hospital, United States	Retros-pective	Septic shock	Selection with ventricular dysfunction by echocardiography and medical record	28- day mortality	Adjusted	4 2 2
Hiraiwa et al[23]	2021	Single-centre, ICU database, Japan	Retrospective	Septic shock	Selection with ventricular dysfunction by echocardiography and medical record in MIMIC-III	Hospital mortality	Adjusted	4 2 3

HF: Heart failure; ORs: Odds ratios; NOS: Newcastle-Ottawa scale; ICU: Intensive care unit; ISR-SEPSIS: Israeli Sepsis Group database; SOFA: Sequential organ failure assessment; MIMIC-III: Medical Information Mart for Intensive Care III database.

Table 2 Patient characteristics in the studies

Ref.	Sample size (M/F)	HF (n)	Disease-related score (median or range)	Sepsis mortality	Age (median or range)	Hospital/ICU LOS (days in median or range)	Mechanical ventilation	Charlson comorbidity index (median or range)
Grozdanovski et al[19]	184 (122/62)	65	N/A	95 (51.6%)	57.1 (17.9)	13 (9-20)	N/A	N/A
cui et al[9]	338 (235/103)	24	APACHEII: 14.0 (7.4); SOFA: 6.1 (4.1)	114 (33.7%)	55.8 (18.7)	14.3 (9.35)	N/A	1.2 (1.5)
Lemay et al[4]	2727 (2687/40)	713	N/A	1501 (55.0%)	76 (6.5)	N/A	661 (24.2%)	3.5 (2.6)
Mourad et al[20]	72 (32/40)	33	SAPS II: 57 (45.7-69); SOFA: 11 (9-13)	35 (48.6%)	58 (49-66)	8 (4-12.2)	30 (42%)	N/A
Vallabhajosyula et al[12]	388 (198/190)	214	APACHE-III: 83.5 (67.8-106.3); SOFA: 8.7 (6.3-11.7)	218 (56.2%)	66.5 (54.6-76.5)	N/A	213 (54.9%)	5.33 (3.33-7.67)
Abu-Kaf et al[21]	409 (210/199)	19	N/A	41 (10.02%)	31.5 (7.4)	22 (11-43)	N/A	0.29 (0.64)
Arnautovic et al[6]	109 (48/61)	89	APACHEII: 20 (15-26)	55 (50.5%)	68 (14)	8 (4-13)	73 (67%)	7 (4-9)
Schuler et al[11]	30163 (14500/4815)	19315	N/A	2847 (9.4%)	69.8 (17.1)	3.7 (2.4-6.2)	N/A	N/A
Kim et al[22]	778 (446/332)	45	SOFA: 9 (6-11)	233 (29.9%)	67 (57-74)	3.0 (0.0-8.0)	N/A	N/A
Hiraiwa et al[23]	544 (315/229)	190	SOFA: 13(11-16)	235 (43.2%)	67 (53-78)	6.7 (2.8-13.3)	217 (39.9%)	N/A

HF: Heart failure; APACHE II: Acute physiology and chronic health evaluation II; SOFA: Sequential organ failure assessment; SAPS II: Simplified acute physiology score II; ICU: Intensive care unit; LOS: Length of stay; N/A: Not available.

Table 3 Subgroup analysis of patient mortality

Analysis	N	Ref.	Random-effect model		Fixed-effect model		Heterogeneity
			OR (95%CI)	P	OR (95%CI)	P	I2	Ph
Patient mortality	10	[4,6,9,11,12,19-23]	1.81 (1.34, 2.43)	0	1.08 (1.04, 1.12)	0	0.921	0
Subgroup 1: Prospective	3	[4,19,20]	2.53 (0.97, 6.61)	0.057	1.35 (1.15, 1.59)	0	0.819	0
Retrospective	7	[6,9,11,12,21-23]	1.82 (1.24, 2.66)	0.002	1.07 (1.03, 1.11)	0	0.937	0
Subgroup 2: HF sample size ≥ 100	4	[4,11,12,23]	1.21 (0.90, 1.63)	0.216	1.07 (1.03, 1.11)	0	0.954	0
HF Sample size < 100	6	[6,9,19-22]	4.12 (2.02, 8.41)	0	3.37 (2.29, 4.95)	0	0.681	0.008
Subgroup 3: ICU	7	[6,9,12,19-21,23]	2.88 (1.67, 4.97)	0	1.65 (1.47, 1.86)	0	0.878	0
General hospital	3	[4,11,22]	1.14 (0.93, 1.41)	0.206	1.03 (1.04, 1.12)	0.1	0.726	0.026
Subgroup 4: Hospital or 28-day mortality	6	[6,9,11,19,20,22,23]	3.02 (1.67, 5.49)	0	1.85 (1.63, 2.10)	0	0.742	0.002
long term mortality	4	[4,12,21]	1.18 (0.91, 1.54)	0.207	1.03 (0.99, 1.07)	0.106	0.855	0
Subgroup 5: Average age ≥ 65	6	[4,6,11,12,22,23]	1.29 (0.98, 1.71)	0.075	1.07 (1.04, 1.11)	0	0.928	0
Average age < 65	4	[9,19,21]	6.22 (2.39, 16.18)	0	4.65 (2.86, 7.55)	0	0.703	0.018
Subgroup 6: United States	5	[4,6,11,12,22,23]	1.12 (0.93, 1.34)	0.246	1.03 (0.99, 1.07)	0.112	0.665	0.018
Other countries	5	[9,19-21,23]	4.45 (1.95, 10.12)	0	1.88 (1.66, 2.14)	0	0.836	0

N: Number of studies; 95%CI: 95% confidence interval; Ph: P values of Q test for heterogeneity test; ICU: Intensive care unit.