血清胱抑素C和NT-proBNP对脓毒症心肌病严重程度及预后的预测价值

Predictive Value of Serum Cystatin C and NT-proBNP on Severity and Prognosis of Septic Cardiomyopathy

目的探讨N端脑钠肽前体(NT-proBNP)和胱抑素C(CysC)评估脓毒症心肌病患者病情严重程度及推测其预后的价值。方法选取2020年6月—2021年10月济南市第八人民医院重症医学科收治的脓毒症患者64例,连续3 d(1、3、5 d)监测血清NT-proBN、CysC水平;根据入住ICU时的左室射血分数(EF)分为29例脓毒症心肌病组(SICM组)(EF<50%)和35例非脓毒症心肌病组(非SICM组)(EF≥50%),比较两组血清NT-proBNP,CysC差异,同时随访记录所有病例28 d存活情况。通过受试者工作特征曲线(ROC曲线)评判观察指标对脓毒症心肌病28 d死亡预后的预测价值。结果①64例脓毒症患者,SICM组(共29例,存活11例,死亡18例)病死率明显高于非SICM组(共35例,存活23例,死亡12例),差异有统计学意义(t=4.916,P<0.05)。②SICM组在1、3、5 d的NT-proBNP、CysC水平比非SICM组明显增高,差异有统计学意义(t=-1.938、-9.784、-11.110、-1.986、-5.988、-8.392,P<0.05)。③ROC曲线分析显示,1、3、5 d时,NT-proBNPROC曲线下面积(areaunderROCcurve,AUC)分别为74.2%、70.2%、73.7%;CysCAUC分别为73.2%、69.7%、79.8%。结论监测血清NT-proBNP、CysC水平有助于评估脓毒症心肌病患者的严重程度,且对脓毒症心肌病患者28 d转归预测价值较高。

Objective To investigate the value of N-terminal precursor brain natriuretic peptide(NT-proBNP) and cystatin C(Cys C) in assessing the severity and prognosis of patients with septic cardiomyopathy.Methods A total of64 sepsis patients admitted to the Department of Critical Care Medicine of Jinan Eighth People’s Hospital from June2020 to October 2021 were selected. Serum NT-proBN and Cys C levels were monitored for 3 consecutive days(1, 3,and 5 d). According to the left ventricular ejection fraction(EF) at the time of ICU admission, they were divided into29 cases of septic cardiomyopathy group(SICM group)(EF<50%) and 35 cases of non-septic cardiomyopathy group(non-SICM group)(EF ≥50%). The differences in serum NT-proBNP and Cys C between the two groups were compared, and the 28-day survival of all cases was recorded during follow-up. Receiver operating characteristic curve(ROC curve) was used to evaluate the predictive value of observation indicators for 28-day mortality in septic cardiomyopathy.Results 1.Among the 64 sepsis patients, the SICM group(29 cases in total, 11 cases survived and 18 cases died) had significantly higher mortality than the non-SICM group(35 cases in total, 23 cases survived and 12 cases died), and the difference was statistically significant(t=4.916, P<0.05). 2.The levels of NT-proBNP and Cys C in the SICM group on 1, 3, and 5 d were significantly higher than those in the non-SICM group, and the differences were statistically significant(t=-1.938,-9.784,-11.11,-1.986,-5.988,-8.392, P<0.05). 3.The ROC curve analysis showed that at 1, 3, and 5 d, the area under the ROC curve(AUC) of NT-proBNP was 74.2%, 70.2%, and 73.7%, respectively;the CysC AUC was 73.2%, 69.7%, and 79.8%.Conclusion Monitoring serum NT-proBNP and Cys C levels is helpful to assess the severity of patients with septic cardiomyopathy, and has high predictive value for the 28-day outcome of patients with septic cardiomyopathy.