Department of Emergency Medicine and Division of Pulmonary and Critical Care, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, United States.
Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
J Crit Care. 2018 Feb;43:30-35. doi: 10.1016/j.jcrc.2017.08.019. Epub 2017 Aug 12.
The aim of this study was to explore the association of an elevated modified shock index (MSI) in sepsis and myocardial dysfunction.
This single center exploratory retrospective cohort study was conducted at Mayo Clinic from 2011 to 2014. It includes adults admitted to the medical intensive care unit with severe sepsis or septic shock. The time MSI>1.3, area under the curve, in the first 6h was assessed using logistic regression for primary outcomes of myocardial dysfunction and depression and secondary outcomes including mortality and SOFA score.
Overall 578 individuals met inclusion criteria, 169 (29%) developed myocardial dysfunction and 23 (4%) myocardial depression. Adjusted for age, gender, Charlson score, and baseline APACHE 3 score, area MSI>1.3 was associated with increased odds of myocardial dysfunction (OR 1.10, 95% CI 1.00-1.21; p=0.058) and depression (OR 1.28, 95% CI 1.07-1.53; p=0.007). Associations were also seen with ICU mortality (OR 1.17, 95% CI 1.04-1.32; p=0.011), hospital mortality (OR 1.13, 95% CI 1.02-1.25; p=0.025) and SOFA score.
Elevated modified shock index during early sepsis is associated with the development of myocardial dysfunction and depression, SOFA score and mortality.
本研究旨在探讨脓毒症中升高的改良休克指数（MSI）与心肌功能障碍的关系。
本单中心回顾性队列研究于 2011 年至 2014 年在梅奥诊所进行。纳入标准为入住内科重症监护病房的严重脓毒症或感染性休克成人患者。使用逻辑回归评估前 6 小时内 MSI>1.3 的时间、曲线下面积，以评估心肌功能障碍和抑郁的主要结局，以及死亡率和 SOFA 评分等次要结局。
总体上，有 578 人符合纳入标准，其中 169 人（29%）发生心肌功能障碍，23 人（4%）发生心肌抑郁。校正年龄、性别、Charlson 评分和基线 APACHE 3 评分后，MSI>1.3 与心肌功能障碍（OR 1.10，95%CI 1.00-1.21；p=0.058）和抑郁（OR 1.28，95%CI 1.07-1.53；p=0.007）的发生几率增加相关。与 ICU 死亡率（OR 1.17，95%CI 1.04-1.32；p=0.011）、医院死亡率（OR 1.13，95%CI 1.02-1.25；p=0.025）和 SOFA 评分也存在相关性。
脓毒症早期升高的改良休克指数与心肌功能障碍和抑郁、SOFA 评分和死亡率的发生相关。
