心肌肌钙蛋白I独立预测严重脓毒症及感染性休克患者死亡率的价值研究

Cardiac troponin I can independently predicts mortality in patients with severe sepsis and septic shock

目的评价心肌肌钙蛋白I（cTnI）对严重脓毒症及感染性休克患者预后的预测价值。方法回顾性分析2013-01—01～2014—12—31入住我院EICU、ICU的严重脓毒症、感染性休克患者86例的临床资料。按照cTnI是否大于0．08ng／mL分为I组（cTnI≤0．08ng／mL）和Ⅱ组（cTnI〉0．08ng／mL），比较两组总住院病死率、ICU病死率、总住院天数及ICU住院天数。按照人院28d是否存活分为存活组和死亡组，比较两组cTnI是否有差异及其对预后的预测价值。结果一共纳入研究的患者为86例，Ⅰ组与Ⅱ组比较总住院病死率（12．5％vs．50．9％）、ICU病死率（12．5％vs42．6％）差异有统计学意义（P〈0．01），总住院天数[10（7，17）dvs．11（6，20）d]、ICU住院天数[4（2，9）dVS．6（3，9）d1差异元统计学意义（P〉0．05）；存活组体温、呼吸、心率、cTnI、乳酸、器官受累数量及APACHEⅡ评分均较死亡组明显下降（均P〈0．01），而年龄、性别、血压、白细胞、血小板等指标两组比较差异无统计学意义（均P〉0．05）。Logistic回归分析显示，cTnI〉0．08ng／mL、体温、乳酸及器官受累数量对预后有预测价值。结论cTnI〉0．08ng／mL的严重脓毒症及感染性休克患者的总住院病死率、ICU病死率较cTnI≤0．08ng／mL的患者增加，且cTnI可作为预测患者病死率的独立指标。

Objective To evaluate the prognostic value of cardiac troponin I in severe sepsis and septic shock patients. Methods We retrospectively selected 86 severe sepsis and septic shock patients who admitted to EICU, ICU of our hospital from Jan. 1, 2013 to Dee. 13, 2014. According to eTnI levels the patients were divided to group I （cTnI≤0.08 ng/mL） and group 11 （cTnI 〉 0.08 ng/mL）; total hospital mortality, ICU mortality and total hospitalization days and the ICU hospitalization days between the two groups were compared. According to whether the survival of the hospital 28 days they were divided into survival group and death group; cTnI level was statistically compared and its prognostic value was also evaluated. Results A total of 86 patients were recruited in the study. Group I compared with group Ⅱ , the total hospital mortality （12.5% compared to 50.9%, P 〈 0.01）; ICU mortality （12.5% compared to 42.6%, P 〈 0.01 ）; the total number of hospital days [ 10 （7, 17） than 11 （6,20）, P 〉 0.05]; ICU hospitalization days [4 （2,9） than 6 （3,9）, P 〉 0.05]. Survival group compared with death group, its body temperature, breathing, heart rate, eTnI, lactic acid, the number of organ involvement and APACHE Ⅱ scores were significantly lower than those in the death group （P 〈 0.01 ）, but age, sex, blood pres- sure, leukocytes, platelets and other indicators had no obvious difference compared with the death group （P 〉 0.05）. Using logistic regression analysis of cardiac cTnI 〉 0.08 ng/mL, temperature, lactic acid and number of organ involvement can be used as an independent predictor of mortality in hospitalized patients. Conclusion cTnI 〉 0.08 ng/mL in patients with severe sepsis and septic shock, their total hospital mortality rates and ICU mortality increases and cTnI can be used as an independent predictor of mortality.