Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.
Department of Anesthesiology, Sihong People's Hospital, Suqian, 223900, People's Republic of China.
BMC Anesthesiol. 2022 Jun 22;22(1):193. doi: 10.1186/s12871-022-01714-5.
This study aimed to clarify the relevant risk factors of septic cardiomyopathy (SCM) in perioperative sepsis patients.
This retrospective study evaluated patients who were diagnosed with sepsis during the perioperative period and postoperatively admitted to the intensive care unit (ICU) in the Second Affiliated Hospital of Soochow University, the First Affiliated Hospital of Soochow University, and the Suzhou Municipal Hospital between January 2017 and November 2020. They were divided into two groups as the septic cardiomyopathy group (SCM group) and the non-SCM group (NSCM group). Factors with P < 0.1 were compared between groups and were analyzed by multivariate logistic regression to screen the risk factors of sepsis cardiomyopathy. The area under the receiver operating characteristic (ROC) curve was used to verify the discriminative ability of multivariate logistic regression results. Hosmer-Lemeshow goodness of fit test was used to verify the calibration ability of multiple logistic regression results.
Among the 269 patients, 49 patients had SCM. Sequential Organ Failure Assessment (SOFA) score (adjusted odds ratio [AOR] = 2.535, 95% confidence interval (CI): 1.186-1.821, P = 0.000]) and endoscopic surgery (AOR = 3.154, 95% CI: 1.173-8.477, P = 0.023]) were identified to be independent risk factors for SCM. Patients with a SOFA score ≥ 7 had a 46.831-fold higher risk of SCM (AOR =46.831, 95% CI: 10.511-208.662, P < 0.05). The multivariate logistic regression results had good discriminative (area under the curve: 0.902 [95% CI: 0.852-0.953]) and calibration (c = 4.401, P = 0.819) capabilities. The predictive accuracy was 86.2%. The rates of mechanical ventilation and tracheotomy were significantly higher in the SCM group than in the NSCM group (both P < 0.05). The SCM group also had a significantly longer duration of mechanical ventilation (P < 0.05) and significantly higher rates of continuous renal replacement therapy (CRRT) and CRRT-related mortality (P < 0.05). Further, the total length of stay and hospitalization cost were significantly higher in the SCM group than in the NSCM group (P < 0.05).
Endoscopic surgery and SOFA score ≥ 7 during postoperative ICU admission were independent risk factors for SCM within 48 hours postoperatively in patients with perioperative sepsis.
本研究旨在阐明围手术期脓毒症患者发生感染性心肌病（SCM）的相关危险因素。
本回顾性研究纳入了 2017 年 1 月至 2020 年 11 月期间在苏州大学附属第二医院、苏州大学附属第一医院和苏州市立医院重症监护病房（ICU）接受治疗的围手术期脓毒症患者，根据术后是否发生 SCM 将其分为感染性心肌病组（SCM 组）和非感染性心肌病组（NSCM 组）。采用多变量逻辑回归分析筛选 SCM 的危险因素，对 P<0.1 的因素进行组间比较。采用受试者工作特征（ROC）曲线下面积验证多变量逻辑回归结果的判别能力，采用 Hosmer-Lemeshow 拟合优度检验验证多变量逻辑回归结果的校准能力。
在 269 例患者中，49 例发生 SCM。序贯器官衰竭评估（SOFA）评分（调整优势比[OR] = 2.535，95%置信区间[CI]：1.186-1.821，P = 0.000）和内镜手术（OR = 3.154，95%CI：1.173-8.477，P = 0.023）被确定为 SCM 的独立危险因素。SOFA 评分≥7 的患者发生 SCM 的风险增加 46.831 倍（OR = 46.831，95%CI：10.511-208.662，P<0.05）。多变量逻辑回归结果具有良好的判别能力（曲线下面积：0.902[95%CI：0.852-0.953]）和校准能力（c = 4.401，P = 0.819）。预测准确率为 86.2%。SCM 组患者的机械通气和气管切开率明显高于 NSCM 组（均 P<0.05）。SCM 组患者的机械通气时间明显更长（P<0.05），连续性肾脏替代治疗（CRRT）和与 CRRT 相关的死亡率明显更高（P<0.05）。此外，SCM 组患者的总住院时间和住院费用明显高于 NSCM 组（P<0.05）。
术后 ICU 入住期间的内镜手术和 SOFA 评分≥7 是围手术期脓毒症患者术后 48 小时内发生 SCM 的独立危险因素。
