Context: Sepsis is a systemic, comprehensive inflammatory response that can induce serious complications for patients. No uniform definition and diagnostic criteria exist internationally for sepsis related to myocardial injury. Studying factors affecting prognosis for sepsis patients with myocardial injury can be helpful in providing a theoretical basis for clinical diagnosis and treatment.
Objective: The study intended to explore the predictors of the short-term prognosis for septic patients with myocardial injury and to provide a theoretical basis for improving that prognosis.
Design: The research team performed a retrospective study.
Setting: The study took place at the Renmin Hospital at Hubei University of Medicine in Shiyan, Hubei, China.
Participants: Participants were 138 patients with sepsis and myocardial injury at the hospital between January 2018 and February 2021.
Groups: The research team divided participants into a survival group with 114 patients and a mortality group with 24 patients, based on their survival status at six months after being in the hospital.
Outcome measures: The research team collected and analyzed the following data: (1) demographic and clinical characteristics, such as age, gender, underlying disease, and disease severity; (2) echocardiographic indicators, including left ventricular ejection fraction (LVEF), stroke volume (SV), left ventricular end systolic dimension (LVESD), and left ventricular end diastolic dimension (LVEDD); and (3) myocardial injury markers and inflammatory factors, including white blood cell (WBC) count and levels of cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase (CK), C-reactive protein (CRP), and procalcitonin (PCT).
Results: The six-month mortality rate for patients with sepsis with myocardial injury was 17.39%. Compared to the survival group at participants' initial visits to the hospital, the mortality group had a significantly greater age (P = .046), sepsis severity (P < .001), heart rate (P < .001), APACHE II score (P < .001), SOFA score (P < .001), and use of vasoactive drugs (P = .002), and its length of hospital stay was significantly shorter (P < .001). The mortality group's LVEF was significantly lower than that of the survival group (P < .001). The mortality group's levels of WBC, cTnI, NT-proBNP, CK, CRP, and PCT were significantly higher than those in survival group (all P < .001). The univariate analysis found that an age>64 years (P < .001), a high APACHE II score (P < .001), an elevated cTnI (P = .017), an elevated NT-proBNP (P = .029), an elevated CK (P < .001), an elevated CRP (P = .031), and an elevated PCT (P < .001) were risk factors for a poor prognosis for patients. Multifactor logistic regression analysis showed that the risk factors for death were an age > 64 years (P < .001), a high APACHE II score (P < .001), and elevated levels of cTnI (P = .013), NT-proBNP (P < .001), CK (P < .001), CRP (P < .001), and PCT (P = .009).
Conclusion: In summary, risk factors for poor prognosis in septic patients with myocardial injury included age>64 years, high APACHE II, elevated cTnI, elevated NT-proBNP, elevated CK, elevated CRP, and elevated PCT.