摘要
目的探讨左室整体长轴峰值应变(GLPS)对脓毒症患者预后的预测价值。方法采用前瞻性队列研究方法,连续纳入2018年12月至2019年11月就诊于中山大学附属第一医院重症监护病房(ICU)的脓毒症患者作为研究对象。记录患者一般资料、入ICU 24 h内心脏超声指标〔左室射血分数(LVEF)、右室射血分数(RVEF)、四维射血分数(4DEF)、GLPS〕和心肌损伤标志物〔N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)〕、器官支持治疗、病情严重程度及预后指标。比较ICU住院期间不同预后患者临床指标的差异;采用Pearson相关法分析GLPS与其他心脏收缩指标及心脏收缩指标与序贯器官衰竭评分(SOFA)的相关性;绘制受试者工作特征曲线(ROC曲线),分析心脏超声指标及心肌损伤标志物对脓毒症患者ICU住院期间死亡的预测价值。结果最终共纳入50例脓毒症患者,其中ICU住院期间存活40例,死亡10例,病死率20.0%。死亡组全部为男性;与存活组比较,死亡组患者年龄更大,糖尿病及连续性肾脏替代治疗(CRRT)的比例更高,病情更严重,ICU住院时间更长。死亡组患者GLPS和cTnT水平均较存活组显著升高〔GLPS:-7.1%(-8.5%,-7.0%)比-12.1%(-15.5%,-10.4%),cTnT(μg/L):0.07(0.05,0.08)比0.03(0.02,0.13),均P<0.05〕;两组其他心脏超声指标、心肌损伤标志物差异无统计学意义。Pearson相关性分析显示,GLPS与LVEF(r=-0.377,P=0.014)、4DEF(r=-0.697,P=0.000)呈负相关,而与RVEF无相关性(r=-0.451,P=0.069);GLPS与SOFA评分呈正相关(r=0.306,P=0.033),而LVEF(r=0.112,P=0.481)、RVEF(r=-0.134,P=0.595)、4DEF(r=-0.251,P=0.259)与SOFA评分均无相关性。ROC曲线分析显示,GLPS预测脓毒症患者ICU住院期间死亡的ROC曲线下面积(AUC)大于其他心脏收缩指标LVEF、RVEF、4DEF和心肌损伤标志物NT-proBNP、cTnT(0.737比0.628、0.556、0.659、0.580、0.724);当GLPS最佳截断值为-14.9%时,敏感度和阴性预测值达100%。结论脓毒症患者�
Objective To investigate the predictive value of left ventricular global longitudinal peak strain(GLPS)for the prognosis of septic patients.Methods A prospective cohort study was conducted.Patients diagnosed with sepsis and admitted to the intensive care unit(ICU)of the First Affiliated Hospital,Sun Yat-sen University from December 2018 to November 2019 were enrolled.The patient characteristics,cardiac ultrasound parameters[left ventricular ejection fraction(LVEF),right ventricular ejection fraction(RVEF),four-dimensional ejection fraction(4DEF),GLPS]and cardiac biomarkers[N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin T(cTnT)]within 24 hours of ICU admission,organ support therapies,severity of illness,and prognostic indicators were documented.The differences in clinical parameters between patients with varying outcomes during ICU hospitalization were assessed.Pearson correlation analysis was employed to explore the correlation between GLPS and other cardiac systolic parameters,as well as the associations between various cardiac systolic parameters and sequential organ failure assessment(SOFA)score.Receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive capacity of cardiac ultrasound parameters and cardiac biomarkers for death during ICU hospitalization in septic patients.Results A total of 50 septic patients were enrolled,with 40 surviving and 10 dying during ICU hospitalization,resulting in a mortality of 20.0%.All patients in the death group were male.Compared with the survival group,the patients in the death group were older,had a higher prevalence of diabetes mellitus,and received continuous renal replacement therapy(CRRT)more frequently,additionally,they exhibited more severe illness and had longer length of ICU stay.The levels of GLPS and cTnT in the death group were significantly elevated as compared with the survival group[GLPS:-7.1%(-8.5%,-7.0%)vs.-12.1%(-15.5%,-10.4%),cTnT(μg/L):0.07(0.05,0.08)vs.0.03(0.02,0.13),both P<0.05].However,no statistically s
作者
左凌云
宋文亮
刘勇军
吴健锋
管向东
司向
Zuo Lingyun;Song Wenliang;Liu Yongjun;Wu Jianfeng;Guan Xiangdong;Si Xiang(Department of Critical Care Medicine,the First Affiliated Hospital,Sun Yat-sen University,Guangdong Clinical Research Center for Critical Care Medicine,Guangzhou 510080,Guangdong,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2024年第4期353-357,共5页
Chinese Critical Care Medicine
基金
广东省基础与应用基础研究基金(2021A1515111050,2021A1515012056)
中华国际医学交流基金会心血管多学科整合思维研究基金(2022-N-01-14)。
关键词
左室整体长轴峰值应变
脓毒症
预后
Left ventricular global longitudinal peak strain
Sepsis
Prognosis
