Zhang H M, Zhou G S, Zhang Q, Wang X T, Liu D W
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2022 Jun 1;61(6):644-651. doi: 10.3760/cma.j.cn112138-20210803-00527.
To explore the risk factors and prognosis of sepsis-related cardiomyopathy. Patients with sepsis and septic shock admitted to the Critical Care Medicine Department at Peking Union Medical College Hospital from October 2017 to February 2021 were enrolled. Echocardiographic parameters including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and cardiac index (CI) were obtained within 24 h after admission. Hemodynamic parameters including heart rate, mean arterial pressure and central venous pressure were also collected. The risk factors of 45-day mortality were analyzed using Cox regression analysis. Kaplan-Meier survival analysis was performed to compare 45-day mortality among patients with normal left ventricle (LV) systolic function group, sepsis-related takotsubo cardiomyopathy (ST) and septic cardiomyopathy (SC) group as well as between patients with normal right ventricular (RV) function and patients with RV dysfunction. According to LV systolic function, patients were categorized into three groups: normal group [174 (66.9%)], SC group [66 (25.4%)] and ST group [66 (25.4%)]. In comparison with those in normal group, patients in SC group and ST group had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score (<0.05). No difference was found between SC group and ST group regarding APACHE Ⅱ score and SOFA score(>0.05). ST group had lower LVEF [33(28, 41)% vs. 45(38, 48)%, <0.05], CI [2.29 (1.99, 2.53)L·min·m vs. 3.04(2.61, 3.61) L·min·m, <0.05] higher TAPSE [18.6(16.0, 21.2)mm vs. 15.1(12.5, 19.0)mm, <0.05] than SC group. A Cox regression survival analysis showed that right ventricular dysfunction (RVD) was an independent predictor of 45-day mortality (=1.992, 95% 1.088-3.647, =0.025). A Kaplan-Meier analysis revealed no significant difference regarding 45-day mortality among ST group [25.0%(5/20)], SC group [30.3%(20/66)] and normal group 18.4%(32/174)(=0.158). RVD patients [38.0%(30/79)] had significantly higher 45-day mortality than patients with normal RV function [14.9%(27/181),<0.001]. In comparison with SC patients, ST patients tend to have worse LV systolic function, lower cardiac output and better RV function. However, neither ST nor SC is associated with 45-day mortality. RVD is a risk predictor of 45-day mortality, which should be monitored in septic patients.
探讨脓毒症相关性心肌病的危险因素及预后。选取2017年10月至2021年2月在北京协和医院重症医学科住院的脓毒症和脓毒性休克患者。入院后24小时内获取超声心动图参数，包括左心室射血分数（LVEF）、三尖瓣环平面收缩期位移（TAPSE）和心脏指数（CI）。同时收集心率、平均动脉压和中心静脉压等血流动力学参数。采用Cox回归分析45天死亡率的危险因素。进行Kaplan-Meier生存分析，比较左心室（LV）收缩功能正常组、脓毒症相关性应激性心肌病（ST）和脓毒症性心肌病（SC）组患者的45天死亡率，以及右心室（RV）功能正常患者和RV功能障碍患者之间的45天死亡率。根据LV收缩功能，患者分为三组：正常组[174例（66.9%）]、SC组[66例（25.4%）]和ST组[66例（25.4%）]。与正常组相比，SC组和ST组患者的急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）和序贯器官衰竭评估（SOFA）评分更高（<0.05）。SC组和ST组在APACHEⅡ评分和SOFA评分方面无差异（>0.05）。ST组的LVEF更低[33（28，41）%对45（38，48）%，<0.05]，CI更低[2.29（1.99，2.53）L·min·m对3.04（2.61，3.61）L·min·m，<0.05]，TAPSE更高[18.6（16.0，21.2）mm对15.1（12.5，19.0）mm，<0.05]。Cox回归生存分析显示，右心室功能障碍（RVD）是45天死亡率的独立预测因素（=1.992，95% 1.088 - 3.647，=0.025）。Kaplan-Meier分析显示，ST组[25.0%（5/20）]、SC组[30.3%（20/66）]和正常组18.4%（32/174）之间的45天死亡率无显著差异（=0.158）。RVD患者[38.0%（30/79）]的45天死亡率显著高于RV功能正常患者[14.9%（27/181），<0.001]。与SC患者相比，ST患者的LV收缩功能往往更差，心输出量更低，RV功能更好。然而，ST和SC均与45天死亡率无关。RVD是45天死亡率的风险预测因素，应在脓毒症患者中进行监测。
