脓毒症心肌损伤患者的临床特征及预后相关因素分析

Analysis of clinical characteristics and prognosis-related factors in patients with sepsis-induced myocardial injury

目的:探讨脓毒症心肌损伤患者的临床特征以及影响患者预后的相关因素。方法:选取2020年12月至2021年12月期间于浙江大学医学院第一附属医院和衢州市柯城区人民医院诊治的69例脓毒症心肌损伤患者,并根据患者出院后28 d生存情况分为生存组(45例)和死亡组(24例)。比较两组患者的一般资料、实验室相关指标、住院时间及序贯器官衰竭估计(SOFA)评分。采用多因素Logistic回归模型识别脓毒症心肌损伤患者死亡的独立危险因素,并通过绘制受试者工作特征(ROC)曲线评估相关指标对脓毒症心肌损伤患者死亡的预测效能。结果:脓毒症心肌损伤患者的感染部位主要是肺部,死亡组患者既往患高血压[62.50%(15/24)vs.33.33%(15/45),χ^(2)=5.418,P=0.024]、慢性肺疾病[20.83%(5/24)vs.4.44%(2/45),χ^(2)=4.612,P=0.032]的比例,入院时红细胞分布宽度[(15.0±1.6)%vs.(14.0±1.5)%,t=2.426,P=0.018]、SOFA评分[(9±4)分vs.(6±4)分,t=3.457,P=0.001]及血清中白细胞介素6(IL-6)水平[763.00(234.34,2656.94)ng/L vs.94.28(37.03,262.98)ng/L,t=4.158,P<0.001]明显高于生存组,而入院时的体温[(37.2±1.2)℃vs.(37.8±1.0)℃,t=2.312,P=0.024]明显低于生存组。Logistic回归分析发现,脓毒症心肌损伤患者入院时的SOFA评分、体温、IL-6及既往是否患高血压是预测患者死亡的重要影响因素(P均<0.05)。且ROC曲线显示上述4个指标联合检测[曲线下面积(AUC)为0.868,95%置信区间(CI)(0.783,0.952),P<0.001]及血清IL-6水平[AUC为0.806,95%CI(0.694,0.917),P<0.001]均对脓毒症心肌损伤患者死亡具有较好的预测效能。结论:入院时SOFA评分、体温、血清IL-6水平以及既往是否患高血压可对脓毒症心肌损伤患者的临床结局进行预测。

Objective:To explore the clinical characteristics and prognosis-related factors in patients with sepsis-induced myocardial injury.Methods:This study enrolled 69 patients with sepsis induced myocardial injury who were treated at the First Affiliated Hospital of Zhejiang University School of Medicine and Quzhou Kecheng District People's Hospital from December 2020 to December 2021.These patients were divided into the survival group(n=45)and the death group(n=24)according to the 28-day survival after discharge.The general data,laboratory-related indicators,length of hospital stay and sequential organ failure assessment(SOFA)score between the two groups were compared.The multivariate Logistic regression model was used to identify the independent risk factors for death in patients with sepsis-induced myocardial injury,and the predictive efficacies of relevant indicators for death in patients with sepsis-induced myocardial injury were evaluated by drawing receiver operating characteristic(ROC)curves.Results:The infection site of patients with sepsis-induced myocardial injury was mainly located at the lungs.The proportions of previous hypertension[62.50%(15/24)vs.33.33%(15/45),χ^(2)=5.418,P=0.024]and chronic lung disease[20.83%(5/24)vs.4.44%(2/45),χ^(2)=4.612,P=0.032],the width of red blood cell distribution[(15.0±1.6)%vs.(14.0±1.5)%,t=2.426,P=0.018],SOFA score[(9±4)vs.(6±4),t=3.457,P=0.001]and serum interleukin-6(IL-6)level[763.00(234.34,2656.94)ng/L vs.94.28(37.03,262.98)ng/L,t=4.158,P<0.001]at admission in the death group were significantly higher than those in the survival group.However,the body temperature at admission of the patients in the death group was significantly lower than that in the survival group[(37.2±1.2)℃vs.(37.8±1.0)℃,t=2.312,P=0.024].The multivariate Logistic regression analysis revealed that SOFA score,body temperature,serum IL-6 at admission and previous hypertension were all important factors for predicting death in patients with sepsis-induced myocardial injury(all P<0.05).The ROC curve analysis showed that the combined detection of the above four indicators[area under the cure(AUC)=0.868,95%confidence interval(CI)(0.783,0.952),P<0.001]and serum IL-6[AUC=0.806,95%CI(0.694,0.917),P<0.001]both had good predictive efficacies for death in patients with sepsis-induced myocardial injury.Conclusion:SOFA score,body temperature,serum IL-6 at admission and previous hypertension can predict the clinical outcomes of patients with sepsis-induced myocardial injury.