基于左心室整体纵向应变诊断构建脓毒症患者左心室收缩功能障碍的预测模型及预后分析
Construction of a predictive model and prognosis of left ventricular systolic dysfunction in patients with sepsis based on the diagnosis using left ventricular global longitudinal strain.
作者信息
Yu Jiangquan, Zheng Ruiqiang, Yang Penglei, Wang Daxin
机构信息
Medical College, Yangzhou University, Yangzhou, 225001, China.
Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
出版信息
J Intensive Care. 2022 Jun 15;10(1):29. doi: 10.1186/s40560-022-00621-8.
BACKGROUND
Cardiac dysfunction, a common complication of sepsis, is associated with increased mortality. However, its risk factors are poorly understood, and a predictive model might help in the management of cardiac dysfunction.
METHODS
A monocentric prospective study of patients with sepsis was performed. Left ventricular global longitudinal strain (LV GLS) was measured using echocardiography within 72 h of the patients diagnosed with sepsis, and the patients were categorized into two groups: LV GLS > -17%, left ventricular systolic dysfunction group (LVSD group); and LV GLS ≤ -17%, non-left ventricular systolic dysfunction group (Non-LVSD group). The baseline characteristics and prognosis of the two groups were analyzed. Based on the results of the multivariate logistic regression analysis, a predictive model of LVSD was established and a nomogram was drawn.
RESULTS
Fifty-one left ventricular systolic dysfunction in patients with sepsis and 73 non-LVSD sepsis patients were included. Prognostic analysis showed that patients with LVSD had higher ICU mortality, in-hospital mortality, the incidence of atrial fibrillation (P < 0.05), and risk of death (HR = 3.104, 95% CI = 1.617-5.957, P < 0.001) compared to patients with non-LVSD. There were no significant differences in the rate of tracheal intubation, the incidence of acute kidney injury (AKI), the proportion of continuous renal replacement therapy (CRRT), length of ICU stay, and length of hospital stay between the 2 groups (P > 0.05). High sensitive troponin I (Hs-TnI) ≥ 0.131 ng/ml, procalcitonin (PCT) ≥ 40 ng/ml, lactate (Lac) ≥ 4.2 mmol/L, and N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥ 3270 pg/ml were found to be the best cut-off values for the prediction of LVSD.
CONCLUSION
Sepsis patients with left ventricular systolic dysfunction had a higher risk of death and atrial fibrillation. Hs-TnI, PCT, Lac, and NT-proBNP were independent risk factors of LVSD, and the LVSD predictive model constructed using these factors showed good diagnostic performance.
TRIAL REGISTRATION
Chinese Clinical Trial Registry No: ChiCTR2000032128. Registered on 20 April 2020, http://www.chictr.org.cn/showproj.aspx ?proj=52531.
背景
心脏功能障碍是脓毒症的常见并发症，与死亡率增加相关。然而，其危险因素尚不清楚，预测模型可能有助于心脏功能障碍的管理。
方法
对脓毒症患者进行单中心前瞻性研究。在确诊脓毒症的患者72小时内，使用超声心动图测量左心室整体纵向应变（LV GLS），并将患者分为两组：LV GLS＞-17%，左心室收缩功能障碍组（LVSD组）；LV GLS≤-17%，非左心室收缩功能障碍组（非LVSD组）。分析两组的基线特征和预后。基于多因素逻辑回归分析结果，建立LVSD预测模型并绘制列线图。
结果
纳入51例脓毒症左心室收缩功能障碍患者和73例非LVSD脓毒症患者。预后分析显示，与非LVSD患者相比，LVSD患者的ICU死亡率、住院死亡率、心房颤动发生率（P＜0.05）和死亡风险（HR=3.104，95%CI=1.617-5.957，P＜0.001）更高。两组间气管插管率、急性肾损伤（AKI）发生率、持续肾脏替代治疗（CRRT）比例、ICU住院时间和住院时间无显著差异（P＞0.05）。高敏肌钙蛋白I（Hs-TnI）≥0.131 ng/ml、降钙素原（PCT）≥40 ng/ml、乳酸（Lac）≥4.2 mmol/L和N末端脑钠肽前体（NT-proBNP）≥3270 pg/ml被发现是预测LVSD的最佳截断值。
结论
脓毒症左心室收缩功能障碍患者的死亡和心房颤动风险更高。Hs-TnI、PCT、Lac和NT-proBNP是LVSD的独立危险因素，使用这些因素构建的LVSD预测模型具有良好的诊断性能。
试验注册
中国临床试验注册中心编号：ChiCTR2000032128。于2020年4月20日注册http://www.chictr.org.cn/showproj.aspx?proj=52531。
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