Lu Nian-Fang, Niu Hong-Xia, Liu An-Qi, Chen Ya-Lei, Liu Hu-Nan, Zhao Pei-Hong, Shao Jun, Xi Xiu-Ming
Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, People's Republic of China.
Department of Emergency, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, People's Republic of China.
Risk Manag Healthc Policy. 2024 Apr 23;17:1015-1025. doi: 10.2147/RMHP.S452803. eCollection 2024.
To explore the prognostic outcomes associated with different types of septic cardiomyopathy and analyze the factors that exert an influence on these outcomes.
The data collected within 24 hours of ICU admission included cardiac troponin I (cTnI), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP); SOFA (sequential organ failure assessment) scores, and the proportion of vasopressor use. Based on echocardiographic outcomes, septic cardiomyopathy was categorized into left ventricular (LV) systolic dysfunction, LV diastolic dysfunction, and right ventricular (RV) systolic dysfunction. Differences between the mortality and survival groups, as well as between each cardiomyopathy subgroup and the non-cardiomyopathy group were compared, to explore the influencing factors of cardiomyopathy.
A cohort of 184 patients were included in this study, with LV diastolic dysfunction having the highest incidence rate (43.5%). The mortality group had significantly higher SOFA scores, vasopressor use, and cTnI levels compared to the survival group; the survival group had better LV diastolic function than the mortality group ( < 0.05 for all). In contrast to the non-cardiomyopathy group, each subgroup within the cardiomyopathy category exhibited elevated levels of cTnI. The subgroup with left ventricular diastolic dysfunction demonstrated a higher prevalence of advanced age, hypertension, diabetes mellitus, coronary artery disease, and an increased mortality rate; the RV systolic dysfunction subgroup had higher SOFA scores and NT-proBNP levels, and a higher mortality rate ( < 0.05 for all); the LV systolic dysfunction subgroup had a similar mortality rate ( > 0.05).
Patients with advanced age, hypertension, diabetes mellitus, or coronary artery disease are more prone to develop LV diastolic dysfunction type of cardiomyopathy; cardiomyopathy subgroups had higher levels of cTnI. The RV systolic dysfunction cardiomyopathy subgroup had higher SOFA scores and NT-proBNP levels. The occurrence of RV systolic dysfunction in patients with sepsis significantly increased the mortality rate.
探讨不同类型脓毒症性心肌病的预后结局，并分析影响这些结局的因素。
收集入住重症监护病房（ICU）24小时内的数据，包括心肌肌钙蛋白I（cTnI）、N末端脑钠肽前体（NT-proBNP）；序贯器官衰竭评估（SOFA）评分以及血管活性药物使用比例。根据超声心动图结果，将脓毒症性心肌病分为左心室（LV）收缩功能障碍、LV舒张功能障碍和右心室（RV）收缩功能障碍。比较死亡组和存活组之间以及各心肌病亚组与非心肌病组之间的差异，以探讨心肌病的影响因素。
本研究纳入了184例患者，其中LV舒张功能障碍的发生率最高（43.5%）。与存活组相比，死亡组的SOFA评分、血管活性药物使用和cTnI水平显著更高；存活组的LV舒张功能优于死亡组（所有P<0.05）。与非心肌病组相比，心肌病类别中的每个亚组cTnI水平均升高。左心室舒张功能障碍亚组高龄、高血压、糖尿病、冠状动脉疾病的患病率更高，死亡率增加；RV收缩功能障碍亚组的SOFA评分和NT-proBNP水平更高，死亡率更高（所有P<0.05）；LV收缩功能障碍亚组的死亡率相似（P>0.05）。
高龄、高血压、糖尿病或冠状动脉疾病患者更容易发生LV舒张功能障碍型心肌病；心肌病亚组的cTnI水平更高。RV收缩功能障碍性心肌病亚组的SOFA评分和NT-proBNP水平更高。脓毒症患者发生RV收缩功能障碍显著增加死亡率。
