危重症患者左室舒张功能不全与住院死亡率及预后的关系

Relationship between left ventricular diastolic dysfunction and in-hospital mortality and prognosis in critically ill patients

目的观察急诊重症监护病房的危重症患者的左室舒张功能,并分析不同等级的左室舒张功能不全对住院死亡率和预后的影响。方法回顾性研究。连续纳入2015年12月至2016年11月在北京协和医院急诊科、重症监护病房和心脏监护病房需要行床边超声心动图检查的危重患者,记录患者的临床资料及预后,采用二项回归分析及Cox回归分析评估左室舒张功能不全对于住院死亡率及预后的影响。结果最终纳入172例危重患者,149例(86.7%)存在不同程度的左室舒张功能不全,76例(44.2%)为Ⅲ级舒张功能不全,53例(30.8%)在住院期间死亡,21例在中位随访500(12,652)d内死亡。回归分析结果显示,Ⅲ级舒张功能不全的心脏病与住院死亡率(OR=3.63,95%CI:1.27~10.41,P=0.016)和预后不良(HR=2.28,95%CI:1.16~4.48,P=0.017)相关。Ⅲ级舒张功能不全的患者中,Cox回归分析表明,两个以上器官功能障碍(HR=3.80,95%CI:1.27~11.33,P=0.017)、N末端B型利钠肽原水平(HR=1.43,95%CI:1.05~1.94,P=0.022)和左室舒张末期内径(HR=0.935,95%CI:0.89~0.99,P=0.017)均与长期死亡风险相关。结论在累及心脏的危重症患者中,Ⅲ级舒张功能不全可影响其院内死亡率和预后。

Objective To evaluate the diastolic function of critically ill patients in emergency and intensive care units,and to analyze the impact of different levels of diastolic dysfunction on hospital mortality and prognosis.Methods The study consecutively enrolled critical patients requiring bedside echocardiography in emergency room,intensive care unit and cardiac care unit in Peking Union Medical College Hospital from December 2015 to November 2016.Diastolic function was assessed by echocardiography.Clinical data and prognosis were recorded.In-hospital mortality were analyzed by binomial regression analysis.Cox regression analyses were conducted to evaluate diastolic dysfunction on long-term outcome.Results A total of 172 patients were enrolled,and 149(86.7%)had varying degrees of diastolic insufficiency,76(44.2%)had grade Ⅲ diastolic insufficiency,53(30.8%)died during hospitalization,and 21 patients died within 500.48(12.40,652.99)days of follow-up.Only patients with grade Ⅲ diastolic insufficiency were associated with in-hospital mortality(OR=3.63,95%CI:1.27-10.41,P=0.016)and poor prognosis(HR=2.28,95%CI:1.16-4.48,P=0.017).In patients with heart-related diseases and grade Ⅲ diastolic insufficiency,Cox regression analysis showed that two or more organ dysfunctions(HR=3.80,95%CI:1.27-11.33,P=0.017),N-terminal pro-brain natriuretic peptide level(HR=1.43,95%CI:1.05-1.94,P=0.022)and left ventricular end-diastolic diameter(HR=0.935,95%CI:0.89-0.99,P=0.017)were associated with long-term mortality risk.Conclusions In critically ill patients with heart involvement,grade Ⅲ diastolic dysfunction can affect their in-hospital mortality and prognosis.