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脓毒症相关心肌损伤:发病率与死亡率

Sepsis-associated myocardial injury: Incidence and mortality.

作者信息

Zhou Ye-Ting, Wang Guang-Sheng, Gao Xin-Chun, Wang Shao-Dan, Wang Si-Wei, Tong Dao-Ming

机构信息

Affiliated Shuyang Hospital, Xuzhou Medical University, Jiangsu, China.

NICU, Affiliated Shuyang Hospital, Xuzhou Medical University, Jiangsu, China.

出版信息

Medicine (Baltimore). 2025 Jun 20;104(25):e42513. doi: 10.1097/MD.0000000000042513.

Abstract

The incidence and mortality associated with sepsis myocardial injury (SAMI) remain understudied. We aimed to explore whether the 4 myocardial injury markers (MIMs) scores in the Intensive Care Units (ICU) were associated with the incidence and mortality of patients with SAMI. A retrospective study collected data from 316 adult SAMI patients who underwent MIMs tests on the ICU (January 1, 2017-January 1, 2020) of the Shuyang Hospital in China, and the predictors of mortality were determined using multivariable Cox models. Between January 1, 2017 and January 1, 2020, 316 (61.1 %) adults were diagnosed with SAMI in a consecutive sample of 517 admissions. A total of 177 (56.0%) patients with SAMI died at 28 days follow-up, and its initial (24 hours) MIMs score, highest MIMs scores (>80 hours), sepsis-associated organ failure assessment (SOFA) score, systemic inflammatory response syndrome (SIIRS) point, and inflammation markers were significantly different between the survival and non-survival group (all P < .05). We found that a initial elevated MIMs score (hazard ratios [HR], 6.4; 95% CI = 4.298-11.48), high SIRS point (HR, 3.2; 95% CI = 1.249-5.115), high SOFA score (HR, 3.6; 95% CI = 1.315-5.974), and highest MIMs score (HR, 6.8; 95% CI = 4.379-11.53) were associated with high mortality for SAMI. The area under the ROC curve for mortality of SAMI was significantly larger for the highest MIMs score (0.88, 95% CI = 0.85-0.96) than for the initial MIMs score (0.84, 95% CI = 0.80-0.87) (P < .001). High MIMs scores in SAMI was associated with high mortality, suggesting that a greater need to predict outcomes and active treatment SAMI to reduce mortality, in addition to timely antibiotic treatment.

摘要

脓毒症心肌损伤(SAMI)的发病率和死亡率仍未得到充分研究。我们旨在探讨重症监护病房(ICU)中的4种心肌损伤标志物(MIMs)评分是否与SAMI患者的发病率和死亡率相关。一项回顾性研究收集了中国沭阳医院ICU(2017年1月1日至2020年1月1日)接受MIMs检测的316例成年SAMI患者的数据,并使用多变量Cox模型确定死亡率的预测因素。在2017年1月1日至2020年1月1日期间,在517例连续入院患者样本中,316例(61.1%)成年人被诊断为SAMI。共有177例(56.0%)SAMI患者在28天随访时死亡,其初始(24小时)MIMs评分、最高MIMs评分(>80小时)、脓毒症相关器官功能衰竭评估(SOFA)评分、全身炎症反应综合征(SIIRS)评分以及炎症标志物在存活组和非存活组之间存在显著差异(所有P<0.05)。我们发现,初始MIMs评分升高(风险比[HR],6.4;95%置信区间=4.298-11.48)、高SIRS评分(HR,3.2;95%置信区间=1.249-5.115)、高SOFA评分(HR,3.6;95%置信区间=1.315-5.974)以及最高MIMs评分(HR,6.8;95%置信区间=4.379-11.53)与SAMI的高死亡率相关。SAMI死亡率的ROC曲线下面积,最高MIMs评分(0.88,95%置信区间=0.85-0.96)显著大于初始MIMs评分(0.84,95%置信区间=0.80-0.87)(P<0.001)。SAMI中高MIMs评分与高死亡率相关,这表明除了及时进行抗生素治疗外,更需要预测预后并积极治疗SAMI以降低死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/579f/12187275/de2061b1bff8/medi-104-e42513-g001.jpg

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