Department of Cardiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Shijiazhuang, China.
Ann Palliat Med. 2021 Dec;10(12):12420-12430. doi: 10.21037/apm-21-3223.
This study aimed to investigate the clinical manifestations and risk factors for 28-day mortality in patients with stress cardiomyopathy (SC) in the intensive care unit (ICU).
This retrospective study was carried out from April 2015 to March 2021. Fifty-five patients in the ICU were diagnosed with SC. Two patients were excluded due to a history of atrial fibrillation (AF), and 53 patients were enrolled in the study. Baseline demographics and clinical characteristics were collected, and the 28-day mortality rate was calculated. Multivariate and univariate logistic regression analyses were used to determine the significant predictors of 28-day mortality.
Of the 53 patients, almost half (47.17%) were male. The most common stress trigger was sepsis (37.74%). Due to sedation and tracheal intubation, 49.06% of SC patients were unable to express their symptoms, and only 3.77% of patients presented with chest pain. The proportion of patients with complications of systolic heart failure and cardiogenic shock was 77.36% and 39.62%, respectively. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score when patients were admitted into the ICU was 21.17±8.41, and the Sequential Organ Failure Assessment (SOFA) score at diagnosis of SC was 9.30±4.56. Eighteen (33.96%) SC patients had new-onset AF while in the ICU. The 28-day mortality rate in patients with SC in the ICU was 64.15%. Univariate analysis found that 5 variables [SOFA score at diagnosis of SC, estimated glomerular filtration rate (eGFR) <60 mL/min at diagnosis of SC, maximum norepinephrine dose, new-onset AF, and systolic heart failure] were correlated with 28-day mortality in patients with SC in the ICU. Multivariate logistic regression analysis suggested SOFA score at diagnosis of SC (P=0.042), eGFR <60 mL/min at diagnosis of SC (P=0.027), and new-onset AF (P=0.043) as independent predictors of 28-day mortality.
Male patients with SC were relatively more common in the ICU than in the cardiology unit. Sepsis was a common stress trigger. The 28-day mortality rate was very high. The SOFA score and eGFR <60 mL/min at diagnosis of SC and new-onset AF may have influenced patients' short-term prognosis.
本研究旨在探讨重症监护病房（ICU）应激性心肌病（SC）患者 28 天死亡率的临床表现和危险因素。
本回顾性研究于 2015 年 4 月至 2021 年 3 月进行。55 例 ICU 患者被诊断为 SC。由于房颤（AF）病史，排除 2 例患者，共纳入 53 例患者进行研究。收集基线人口统计学和临床特征，并计算 28 天死亡率。采用多变量和单变量逻辑回归分析确定 28 天死亡率的显著预测因素。
在 53 例患者中，近一半（47.17%）为男性。最常见的应激触发因素是败血症（37.74%）。由于镇静和气管插管，49.06%的 SC 患者无法表达症状，只有 3.77%的患者出现胸痛。收缩性心力衰竭和心源性休克并发症的患者比例分别为 77.36%和 39.62%。患者入住 ICU 时急性生理学和慢性健康评估（APACHE）Ⅱ评分的平均值为 21.17±8.41，SC 诊断时序贯器官衰竭评估（SOFA）评分为 9.30±4.56。18 例（33.96%）SC 患者在 ICU 期间新发 AF。SC 患者在 ICU 中的 28 天死亡率为 64.15%。单因素分析发现，5 个变量[SC 诊断时的 SOFA 评分、SC 诊断时估计肾小球滤过率（eGFR）<60 mL/min、最大去甲肾上腺素剂量、新发 AF 和收缩性心力衰竭]与 SC 患者 28 天死亡率相关。多因素 logistic 回归分析表明，SC 诊断时的 SOFA 评分（P=0.042）、SC 诊断时 eGFR<60 mL/min（P=0.027）和新发 AF（P=0.043）是 28 天死亡率的独立预测因素。
与心内科相比，男性 SC 患者在 ICU 中更为常见。败血症是常见的应激触发因素。28 天死亡率非常高。SC 诊断时的 SOFA 评分和 eGFR<60 mL/min 以及新发 AF 可能影响患者的短期预后。
