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右心室肺动脉耦联在评估脓毒症患者预后中的价值。

The value of right ventricular pulmonary artery coupling in determining the prognosis of patients with sepsis.

机构信息

Department of Ultrasound, First Affiliated Hospital of Wannan Medical College, No.2 Zheshan West Road, Wuhu, 241001, Anhui, People's Republic of China.

Department of Physiology, Wannan Medical College, Wuhu, People's Republic of China.

出版信息

Sci Rep. 2024 Jul 3;14(1):15283. doi: 10.1038/s41598-024-65738-2.

Abstract

The outcomes of patients with sepsis are influenced by the contractile function of the right ventricle (RV), but the impact of cardiopulmonary interaction in ICU-mortality of sepsis patients remains unclear. This study aims to investigate the ICU-mortality impact of right ventricular-pulmonary artery (RV-PA) coupling in patients with sepsis. We employed echocardiography to assess patients with sepsis within the initial 24 h of their admission to the ICU. RV-PA coupling was evaluated using the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio. A total of 92 subjects were enrolled, with 55 survivors and 37 non-survivors. TAPSE/PASP ratio assessed mortality with an area under the curve (AUC) of 0.766 (95% CI 0.670-0.862) and the optimal cutoff value was 0.495 mm/mmHg. We constructed a nomogram depicting the TAPSE/PASP in conjunction with IL-6 and Lac for the joint prediction of sepsis prognosis, and demonstrated the highest predictive capability (AUC = 0.878, 95% CI 0.809-0.948). In conclusion, the TAPSE/PASP ratio demonstrated prognostic value for ICU mortality in sepsis patients. The nomogram, which combines the TAPSE/PASP, IL-6, and LAC, demonstrated enhanced predictive efficacy for the prognosis of sepsis patients.

摘要

患者脓毒症的结局受右心室(RV)收缩功能的影响,但心肺相互作用对 ICU 脓毒症患者死亡率的影响尚不清楚。本研究旨在探讨 RV-PA 耦联对脓毒症患者 ICU 死亡率的影响。我们在 ICU 入院后 24 小时内采用超声心动图评估脓毒症患者。采用三尖瓣环平面收缩期位移(TAPSE)与肺动脉收缩压(PASP)比值评估 RV-PA 耦联。共纳入 92 例患者,其中 55 例存活,37 例死亡。TAPSE/PASP 比值评估死亡率的曲线下面积(AUC)为 0.766(95%CI 0.670-0.862),最佳截断值为 0.495mm/mmHg。我们构建了一个列线图,描述了 TAPSE/PASP 与 IL-6 和 Lac 联合预测脓毒症预后的情况,结果显示其具有最高的预测能力(AUC=0.878,95%CI 0.809-0.948)。总之,TAPSE/PASP 比值对脓毒症患者 ICU 死亡率具有预后价值。该列线图结合了 TAPSE/PASP、IL-6 和 LAC,对脓毒症患者的预后具有更高的预测效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c16/11222489/df0be42549a3/41598_2024_65738_Fig1_HTML.jpg

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