与感染性休克患者左心室舒张功能障碍相关的因素。

Factors associated with left ventricular diastolic dysfunction in patients with septic shock.

机构信息

Department of Ultrasonography, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China.

Department of Ultrasonography, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.

出版信息

Eur J Med Res. 2022 Jul 27;27(1):134. doi: 10.1186/s40001-022-00761-5.

DOI:10.1186/s40001-022-00761-5

PMID:35897043

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9327319/

Abstract

PURPOSE

To investigate risk factors associated with left ventricular diastolic dysfunction (LVDD) of patients with septic shock.

MATERIALS AND METHODS

Patients with septic shock concomitant with or without LVDD were retrospectively enrolled and divided into the LVDD group (n = 17) and control without LVDD (n = 85). The clinical and ultrasound data were analyzed.

RESULTS

A significant (P < 0.05) difference existed between the two groups in serum creatinine, APACHE II score, serum glucose, triglyceride, BUN, FT4, LAVI, mitral E, average e', E/average e', septal e', septal e'/septal s', E/septal e', lateral s', lateral e', and E/lateral e'. LAVI > 37 mL/m, septal e' < 7 cm/s (OR 11.04, 95% CI 3.38-36.05), septal e'/septal s' < 0.8 (OR 4.09, 95% CI 1.37-12.25), E/septal e' > 15 (OR 22.86, 95% CI 6.09-85.79), lateral e' < 8 cm/s (OR 9.16, 95% CI 2.70-31.07), E/lateral e' > 13 (OR 52, 95% CI 11.99- 225.55), lateral s' < 10 (OR 3.36, 95% CI 1.13-9.99), average e' > 10, E/average e' > 10 (OR 9.53, 95% CI 2.49-36.46), APACHE II score > 16 (OR 3.33, 95% CI 1.00-11.03), SOFA > 5 (or 3.43, 95% CI 1.11-10.60), BUN > 12 mmol/L (OR 3.37, 95% CI 1.15-9.87), serum creatinine > 146 μmol/L (OR 5.08, 95% CI 1.69-15.23), serum glucose > 8 mmol/L (OR 3.36, 95% CI 1.09-10.40), and triglyceride > 1.8 mmol/L were significant (P < 0.05) risk factors for LVDD. LAVI > 37 ml/m, lateral e' < 8 cm/s, E/lateral e' > 13, and SOFA > 5 were significant (P < 0.05) independent risk factors for LVDD. ROC curve analysis demonstrated that the cut-off value and AUC were 37.09 mL/m and 0.85 for LAVI, 8.00 cm/s and 0.89 for lateral e', 12.86 and 0.82 for E/lateral e', and 5.00 and 0.69 for SOFA, respectively.

CONCLUSION

Left atrial volume index, mitral lateral e', E/lateral e', and SOFA score are significant independent risk factors for predicting left ventricular diastolic dysfunction in patients with septic shock.

摘要

目的

探讨与脓毒性休克患者左心室舒张功能障碍（LVDD）相关的危险因素。

材料和方法

回顾性纳入伴有或不伴有 LVDD 的脓毒性休克患者，并将其分为 LVDD 组（n=17）和无 LVDD 对照组（n=85）。分析临床和超声数据。

结果

两组间血清肌酐、APACHE II 评分、血清葡萄糖、甘油三酯、BUN、FT4、左心房容积指数（LAVI）、二尖瓣 E 波、平均 e'、E/average e'、间隔侧 e'、间隔侧 e'/间隔侧 s'、E/间隔侧 e'、外侧 s'、外侧 e'和 E/外侧 e'存在显著差异（P<0.05）。LAVI>37ml/m，间隔侧 e'<7cm/s（OR 11.04，95%CI 3.38-36.05），间隔侧 e'/间隔侧 s'<0.8（OR 4.09，95%CI 1.37-12.25），E/间隔侧 e'>15（OR 22.86，95%CI 6.09-85.79），外侧 e'<8cm/s（OR 9.16，95%CI 2.70-31.07），E/外侧 e'>13（OR 52，95%CI 11.99-225.55），外侧 s'<10cm/s（OR 3.36，95%CI 1.13-9.99），平均 e'>10，E/average e'>10（OR 9.53，95%CI 2.49-36.46），APACHE II 评分>16（OR 3.33，95%CI 1.00-11.03），SOFA>5（或 3.43，95%CI 1.11-10.60），BUN>12mmol/L（OR 3.37，95%CI 1.15-9.87），血清肌酐>146μmol/L（OR 5.08，95%CI 1.69-15.23），血清葡萄糖>8mmol/L（OR 3.36，95%CI 1.09-10.40），甘油三酯>1.8mmol/L 是 LVDD 的显著危险因素（P<0.05）。LAVI>37ml/m，外侧 e'<8cm/s，E/外侧 e'>13，SOFA>5 是 LVDD 的显著独立危险因素（P<0.05）。ROC 曲线分析表明，LAVI 的截断值和 AUC 分别为 37.09ml/m 和 0.85，外侧 e'的截断值和 AUC 分别为 8.00cm/s 和 0.89，E/外侧 e'的截断值和 AUC 分别为 12.86 和 0.82，SOFA 的截断值和 AUC 分别为 5.00 和 0.69。