超声心动图评估重症急性胰腺炎心功能障碍对死亡的预测价值

The predictive effect of echocardiography on the mortality risk of the patients with severe acute pancreatitis by assessing cardiac dysfunction

目的探讨急诊床旁超声心动图心功能评估对重症急性胰腺炎(severe acute pancreatitis,SAP)死亡风险的预测价值。方法回顾性收集2017年1月至2021年6月首都医科大学附属北京世纪坛医院急诊科收治的SAP患者临床资料进行研究。记录基本资料,入院后6 h内及心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、氨基末端B型脑利钠肽原(NT-proBNP)、C反应蛋白(CRP)及降钙素原(PCT)检测最高值,入院24 h内超声心动图心功能指标,28 d病死率,急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、Ranson评分最高值。采用二分类Logistic回归分析SAP患者死亡的预测因素,绘制受试者工作特征(ROC)曲线并分析曲线下面积(AUC),评价其预测效能。结果纳入研究患者78例,APACHEⅡ评分、Ranson评分、SOFA评分、cTnI、乳酸、心率、侧壁二尖瓣环舒张早期峰值流速/舒张晚期峰值流速(E’/A’)、每搏输出量(SV)为SAP患者死亡的预测因素(P<0.05)。E’/A’对SAP患者死亡风险有较好的预测价值,cut-off值为0.75,敏感度为0.754,特异度为0.877,AUC为0.815(95%CI 0.618~0.912),与预测价值较好的APACHEⅡ评分、SOFA评分、cTnI比较差异无统计学意义(P>0.05),与乳酸、心率比较差异有统计学意义(P<0.05);SV对SAP患者死亡风险有一定预测价值,cut-off值为56.5 mL,敏感度为0.786,特异度为0.625,AUC为0.681(95%CI 0.524~0.838),与E’/A’、APACHEⅡ评分、SOFA评分、cTnI比较差异有统计学意义(P<0.05)。E’/A’比SV预测价值高。结论超声心动图心功能评估指标E’/A’对SAP患者死亡有较好预测价值,对SAP患者临床治疗有一定的指导意义,为SAP患者液体管理提供了新的方向。

Objective To investigate the predictive effect of emergency bedside echocardiography on the mortality risk of the patients with severe acute pancreatitis(SAP)by assessing cardiac dysfunction.Methods Patients with SAP admitted to the Emergency Department of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2017 to June 2021 were retrospectively enrolled as the subjects.The basic data of patients were recorded including cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),N-terminal probrain natriuretic peptide(NT-proBNP),C-reactive protein(CRP),procalcitonin(PCT)within 6 h after admission,echocardiography cardiac function indicators at 24 h after admission,28-day mortality,acute physiological and chronic health evaluation(APACHE)Ⅱscore,sequential organ failure score(SOFA)score and Ranson score.Besides,the predictive factors of SAP were analyzed by Logistic regression analysis.To draw the receiver operating characteristic(ROC)curve,to analyze the area under the curve,and to evaluate its predictive efficiency.Results A total of 78 patients were enrolled.APACHEⅡscore,Ranson score,SOFA score,cTnI,lactic acid,heart rate,E′/A′and stroke volume(SV)were important predictors of death in SAP patients(P<0.05).E′/A′had good predictive value for death risk in SAP patients,with cut-off value of 0.75,the sensitivity of 0.754,the specificity of 0.877,and the area under curve of 0.815(95%CI 0.618-0.912),there was no significantly statistical difference compared with APACHEⅡ,SOFA and cTnI(P>0.05),and there was significantly statistical difference compared with lactic acid and heart rate(P<0.05).SV has a certain predictive value for death risk of SAP patients,with cut-off value of 56.5 mL,the sensitivity of 0.786,the specificity of 0.625,and the area under curve of 0.681(95%CI 0.524-0.838),and there was significantly statistical difference compared with E′/A′,APACHEⅡ,SOFA and cTnI(P<0.05).E′/A′has better predictive value than SV.Conclusions Echocardiographic indicators E′/A′has better predictive value for SAP death,which has a certain guiding significance in clinical treatment of SAP patients,and provides a new direction for fluid management of SAP patients.