Lu Nianfang, Zhu Bo, Yang Degang, Zheng Ruiqiang, Shao Jun, Xi Xiuming
Department of Critical Care Medicine, Beijing Electric Power Hospital, Beijing 100073, China.
Department of Critical Care Medicine, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yangzhou 225001, Jiangsu, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Dec;31(12):1457-1461. doi: 10.3760/cma.j.issn.2095-4352.2019.12.005.
To investigate the epidemiology and independent risk factors of septic cardiomyopathy.
A prospective study was conducted. Patients with sepsis in intensive care unit (ICU) of Subei People's Hospital of Jiangsu Province, Yangzhou University, Fuxing Hospital, Capital Medical University and Beijing Electric Power Hospital from May 2016 to August 2019 were enrolled. All patients received standardized treatments according to the Surviving Sepsis Campaign (SSC) guidelines. Blood were collected within 24 hours of admission to ICU, and plasma histone H4, cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were detected by enzyme linked immunosorbent assay (ELISA). Transthoracic echocardiography was performed to record the ultrasonic parameters within 24 hours after admission. Sequential organ failure assessment (SOFA) score, usage of vasopressor drugs, and the prognosis of ICU were recorded. Patients were divided into two groups according to whether cardiomyopathy occurred or not, and the differences of each index between the two groups were compared. The correlation between plasma histone H4 and SOFA score, cTnI, NT-proBNP were investigated. Multivariate binary Logistic regression was used to determine the risk factors for septic cardiomyopathy. The predictive value of histone H4 in septic cardiomyopathy was shown by the receiver operating characteristic (ROC) curve.
121 patients were included in this study, and there were 60 patients (49.6%) with septic cardiomyopathy. Thirty-six patients died, with an ICU mortality of 29.8%. (1) Correlation analysis showed that plasma histone H4 in patients with septic cardiomyopathy was positively correlated with cTnI, SOFA score and NT-proBNP (r value was 0.512, 0.403 and 0.274, respectively, all P < 0.01). (2) Compared with the non-cardiomyopathy group, the plasma histone H4, cTnI, usage of vasopressor drugs, SOFA score and ICU mortality in the cardiomyopathy group were significantly increased [histone H4 (mg/L): 0.26 (0.23, 0.30) vs. 0.22 (0.17, 0.27), cTnI (μg/L): 0.21 (0.17, 0.30) vs. 0.18 (0.14, 0.22), usage of vasopressor drugs: 83.3% (50/60) vs. 65.6% (40/61), SOFA score: 11 (9, 12) vs. 9 (8, 10), ICU mortality: 40.0% (24/60) vs. 19.7% (12/61), all P < 0.05]. Multivariate binary Logistic regression analysis showed that high histone H4 level [odds ratio (OR) = 6.502, 95% confidence interval (95%CI) was 1.203-78.231, P = 0.044] and usage of vasopressor drugs (OR = 2.622, 95%CI was 1.034-6.849, P = 0.042) were independent risk factors for septic cardiomyopathy. (4) ROC curve analysis showed the cut-off of histones H4 for predicting septic cardiomyopathy was 0.24 mg/L, the area under the curve was 0.684 (P < 0.01), with the sensitivity of 65.2%, and specificity of 68.9%.
Septic cardiomyopathy had a high incidence. Higher plasma histone H4 and the usage of vasopressor drugs were independent risk factors for septic cardiomyopathy.
探讨脓毒症性心肌病的流行病学特征及独立危险因素。
进行一项前瞻性研究。纳入2016年5月至2019年8月在江苏省苏北人民医院、扬州大学附属医院、首都医科大学附属复兴医院及北京电力医院重症监护病房（ICU）的脓毒症患者。所有患者均按照拯救脓毒症运动（SSC）指南接受标准化治疗。在入住ICU后24小时内采集血液，采用酶联免疫吸附测定（ELISA）法检测血浆组蛋白H4、心肌肌钙蛋白I（cTnI）和N末端脑钠肽前体（NT-proBNP）。入院后24小时内进行经胸超声心动图检查，记录超声参数。记录序贯器官衰竭评估（SOFA）评分、血管活性药物使用情况及ICU预后。根据是否发生心肌病将患者分为两组，比较两组各指标的差异。研究血浆组蛋白H4与SOFA评分、cTnI、NT-proBNP之间的相关性。采用多因素二元Logistic回归分析确定脓毒症性心肌病的危险因素。通过受试者工作特征（ROC）曲线展示组蛋白H4对脓毒症性心肌病的预测价值。
本研究共纳入121例患者，其中60例（49.6%）发生脓毒症性心肌病。36例患者死亡，ICU死亡率为29.8%。（1）相关性分析显示，脓毒症性心肌病患者血浆组蛋白H4与cTnI、SOFA评分及NT-proBNP呈正相关（r值分别为0.512、0.403和0.274，均P<0.01）。（2）与非心肌病组相比，心肌病组血浆组蛋白H4、cTnI、血管活性药物使用情况、SOFA评分及ICU死亡率均显著升高[组蛋白H4（mg/L）：0.26（0.23，0.30）对0.22（0.17，0.27），cTnI（μg/L）：0.21（0.17，0.30）对0.18（0.14，0.22），血管活性药物使用情况：83.3%（50/60）对65.6%（40/61），SOFA评分：11（9，12）对9（8，10），ICU死亡率：40.0%（24/60）对19.7%（12/61），均P<0.05]。多因素二元Logistic回归分析显示，高组蛋白H4水平[比值比（OR）=6.502，95%置信区间（95%CI）为1.203 - 78.231，P = 0.044]及血管活性药物使用情况（OR = 2.622，95%CI为1.034 - 6.849，P = 0.042）是脓毒症性心肌病的独立危险因素。（4）ROC曲线分析显示，预测脓毒症性心肌病的组蛋白H4截断值为0.24 mg/L，曲线下面积为0.684（P<0.01），灵敏度为65.2%，特异度为68.9%。
脓毒症性心肌病发病率较高。较高的血浆组蛋白H4水平及血管活性药物使用情况是脓毒症性心肌病的独立危险因素。
