急诊科脓毒症患者并发脓毒症心肌病高危因素的回顾性队列研究

Retrospective cohort study on risk factors for patients with sepsis combined with septic cardiomyopathy in Emergency Department

目的探讨代谢、感染、生化等检验指标是否与脓毒症患者并发心肌损伤相关。方法收集2021年6月-2023年9月在某三甲医院急诊科497例确诊为脓毒症或脓毒性休克成人患者(年龄≥18岁),根据是否并发SIC,分为SIC组和非SIC组。采用回顾性研究的方法统计所有入选患者的临床资料,比较SIC组和非SIC组患者的指标差异,通过ROC计算Cutt-off值,随后采用COX回归(向前逐步法)分析脓毒症患者发生心肌损伤可能的高危因素,并通过Kaplan-Meier进行生存分析。结果497例患者中SIC组201例,非SIC组296例。SIC组死亡率为33.81%(68/201),非SIC组死亡率为13.51%(40/296),二者的生存差异有统计学意义。SIC组BUN、Cr、UA、TT3、TT4、FT3、FT4、PCT、CRP、IL-6、IL-10、铁蛋白均高于非SIC组;TC、TSH、PLT均低于非SIC组,差异有统计学意义(P<0.05)。Cr≥84.5、BUN≥8.35、IL-10≥11.75、尿酸≥116.50可作为SIC患者的预测指标,其中BUN升高并发SIC的风险比增加(HR=1.86,P=0.049)。结论BUN升高是脓毒症并发心肌病的高危因素。

Objective To explore whether metabolic,infection,biochemical and other test indicators are related to myocardial injury in patients with sepsis.Methods It collected 497 adult patients(aged≥18 years)diagnosed with sepsis or septic shock in the emergency department of a top three hospital from June 2021 to September 2023,and divide them into sepsis-induced cardiomyopathy group and non-sepsis-induced cardiomyopathy group based on whether they were complicated with sepsis-induced cardiomyopathy(SIC).A retrospective study was used to collect clinical data from all selected patients,compared the differences in indicators between the sepsis-induced cardiomyopathy group and the non-sepsis-induced cardiomyopathy group,calculated the cut-off values by ROC,and then used COX regression(forward stepwise method)to analyze the possible high-risk factors for myocardial injury in sepsis patients.Survival analysis was performed by Kaplan Meier.Results Among the 497 patients,there were 201 cases in the SIC group and 296 cases in the non-SIC group.The mortality rate in the SIC group was 33.81%(68/201),while in the non-SIC group was 13.51%(40/296),indicating a statistically significant difference in survival between the two groups.The levels of BUN,Cr,UA,TT3,TT4,FT3,FT4,PCT,CRP,IL-6,IL-10,and ferritin in the SIC group were higher than those in the non-SIC group;TC,TSH and PLT were all lower than those in the non-SIC group,with statistically significant differences(P<0.05).CR≥84.5,Bun≥8.35,IL-10≥11.75,uric acid≥116.50 could be used as a predictor in patients with septic cardiomyopathy,in which the risk ratio of increased BUN complicated with SIC increased(HR=1.86,P=0.049).Conclusions BUN increased is a high-risk factor for sepsis complicated with cardiomyopathy.