Sepsis-associated myocarditis: Epidemiology, pathophysiology, diagnosis, management, and future directions

Abstract

Sepsis-associated myocarditis is a major challenge in critical care, driving global morbidity and mortality through cardiac dysfunction. Despite advances in diagnostics, consensus on optimal management remains lacking. This review explores epidemiology, clinical complexities, and research gaps. A systematic search of OVID MEDLINE and Scopus (2000-2025) using terms "sepsis," "myocarditis," "cardiac dysfunction," and "inflammatory cardiomyopathy" identified 10,344 records. After removing duplicates (2323) and applying filters for human studies (1840), English language (1775), and publication year (1340), 87 articles were eligible. Thirty were excluded for lacking outcome data, leaving 57 studies for final analysis, supplemented by 13 additional articles that highlight therapeutic strategies, emerging directions, and supportive evidence. Study quality was assessed using PRISMA 2020 guidelines. Sepsis-associated myocarditis is characterized by myocardial inflammation and impaired cardiac function, often worsened by systemic inflammatory responses. Left ventricular dysfunction is frequent, influenced by infectious agents, immune dysregulation, and drug toxicities. While diagnostic modalities have improved, therapeutic approaches remain inconsistent, with no standardized protocols established. Current management typically involves intravenous fluids, antibiotics, and vasopressors, yet patient outcomes vary widely. The absence of consensus highlights an urgent need for targeted research to clarify mechanisms, define effective interventions, and improve survival in this high-risk population.