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Myocardial dysfunction with sepsis — Clinical Guidelines

Overview

Sepsis is a life-threatening condition characterized by acute, life-threatening multiple organ dysfunction triggered by an infection 1. Myocardial dysfunction is a recognized complication of sepsis, contributing to overall organ failure 1.

Diagnosis

Mid-regional pro-adrenomedullin (MR-proADM) demonstrates high sensitivity (0.83) and specificity (0.90) for sepsis diagnosis, with an optimal cut-off value of 1-1.5 nmol/L 5.

MR-proADM may also aid in distinguishing pathogens, identifying sepsis severity, and assessing organ failure 5.

Point-of-care ultrasound (POCUS) can be used for shock assessment 2.

Management

Early enteral nutrition (EEN) within 48 hours may be safe and effective for critically ill patients with sepsis or septic shock 4.

Therapeutic plasma exchange (TPE) as an adjunct to standard therapy significantly reduced short-term mortality in critically ill adult septic patients 3.

Guidelines address diagnosis and treatment of infection and organ failure in sepsis 1.

Special Populations

No specific information regarding myocardial dysfunction in pregnancy, pediatrics, elderly, or patients with comorbidities during sepsis was found in the provided abstracts.

Key Recommendations

Therapeutic plasma exchange (TPE) as an adjunct to standard care significantly reduced short-term mortality in critically ill adult septic patients 3. (Evidence: Strong)

Early enteral nutrition (EEN) within 48 hours may be a safe and effective intervention for critically ill patients with sepsis or septic shock 4. (Evidence: Weak)

Mid-regional pro-adrenomedullin (MR-proADM) is an excellent biomarker for sepsis diagnosis with high sensitivity and specificity, with an optimal cut-off of 1-1.5 nmol/L 5. (Evidence: Strong)

References

1 Brunkhorst FM, Adamzik M, Axer H, Bauer M, Bode C, Bone HG et al.. [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025]. Medizinische Klinik, Intensivmedizin und Notfallmedizin 2025. link 2 Liu Q, Ma X, Li S, Li Z, Mo Z, Lin Y et al.. Effectiveness of a multi-model teaching strategy to train emergency medicine residents to use point-of-care ultrasound (POCUS) for assessment of shock. BMC medical education 2025. link 3 Kuklin V, Sovershaev M, Bjerner J, Keith P, Scott LK, Thomas OMT et al.. Influence of therapeutic plasma exchange treatment on short-term mortality of critically ill adult patients with sepsis-induced organ dysfunction: a systematic review and meta-analysis. Critical care (London, England) 2024. link 4 Grillo-Ardila CF, Tibavizco-Palacios D, Triana LC, Rugeles SJ, Vallejo-Ortega MT, Calderón-Franco CH et al.. Early Enteral Nutrition (within 48 h) for Patients with Sepsis or Septic Shock: A Systematic Review and Meta-Analysis. Nutrients 2024. link 5 Li P, Wang C, Pang S. The diagnostic accuracy of mid-regional pro-adrenomedullin for sepsis: a systematic review and meta-analysis. Minerva anestesiologica 2021. link 6 Ge L, Zhao J, Deng H, Chen C, Hu Z, Zeng L. Effect of Bone Marrow Mesenchymal Stromal Cell Therapies in Rodent Models of Sepsis: A Meta-Analysis. Frontiers in immunology 2021. link

Myocardial dysfunction with sepsis