摘要
目的:观察左心室整体纵向应变(LVGLS)和左室射血分数(LVEF)对脓毒性心肌病(SIC)病人预后的预测价值。方法:回顾性选取2022年9月—2023年12月我院收治的108例SIC病人临床资料,根据28 d存活情况将其分为生存组与病死组,比较两组病人临床资料、入院时左心室应变参数与心功能指标,采用多因素Logistic回归分析SIC病人预后水平的影响因素,并采用受试者工作特征(ROC)曲线分析LVGLS、LVEF对SIC病人预后的预测价值。结果:108例SIC病人中,随访28 d共35例病人死亡,纳入病死组,剩余73例纳入生存组。病死组病人入院24 h内的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、肌钙蛋白I(cTnI)及血乳酸(Lac)水平均高于生存组(P<0.05),LVGLS绝对值、整体径向应变(GRS)绝对值及LVEF均低于生存组(P<0.05),且多因素Logistic回归分析显示,APACHEⅡ评分、cTnI、Lac、LVGLS及LVEF是SIC病人预后的独立影响因素(P<0.05)。ROC特征曲线结果显示,LVGLS预测SIC病人预后水平的最佳截断值为-12.33%,LVEF最佳截断值为29.43%,且LVGLS联合LVEF预测SIC病人预后的曲线下面积(AUC)及敏感度均高于单一指标预测(P<0.05)。结论:入院时APACHEⅡ评分、cTnI、Lac、LVGLS及LVEF水平均为SIC病人预后的独立影响因素,且LVGLS联合LVEF对SIC病人预后具有较高的预测价值,可作为预后评估的主要临床指标,建议予以重点关注。
Objective:To observe the prognostic value of left ventricular global longitudinal strain(LVGLS)and left ventricular ejection fraction(LVEF)in patients with sepsis-induced cardiomyopathy(SIC).Methods:The clinical data of 108 patients with SIC were retrospectively selected and divided into survival group and death group according to the 28 d survival.The clinical data,left ventricular strain parameters and cardiac function indicators were compared between the two groups.Multiple Logistic regression was used to analyze the factors affecting prognosis of SIC patients.Receiver operating characteristic(ROC)curve was used to analyze the prognostic value of LVGLS and LVEF in SIC patients.Results:Among the 108 patients with SIC,35 patients died(death group)and 73 patients survived(survival group)during 28 d of follow up.The levels of Acute Physiology and Chronic Health Status ScoreⅡ(APACHEⅡ),Sequential Organ Failure Score(SOFA),troponin I(cTnI)and blood lactic acid(Lac)in death group were higher than those in survival group within 24 h after admission(P<0.05),LVGLS absolute value,GRS absolute value and LVEF were lower than those of the survival group(P<0.05).Multiple Logistic regression analysis showed that APACHEⅡscore,cTnI,Lac,LVGLS,and LVEF were independent prognostic factors of SIC patients(P<0.05).ROC curve results showed that the best cutoff value for LVGLS to predict the prognosis of SIC patients was-12.33%,the best cutoff value for LVEF were 29.43%.The area under the curve(AUC)and sensitivity of LVGLS combined with LVEF to predict the prognosis of SIC patients were higher than those predicted by single index(P<0.05).Conclusion:APACHEⅡscore,cTnI,Lac,LVGLS,and LVEF levels at admission are independent prognostic factors of SIC patients.LVGLS combined with LVEF shows a high prognostic value for SIC patients,and can be used as the main clinical index for prognosis evaluation.
作者
邱黎菲
江利东
姜远普
QIU Lifei;JIANG Lidong;JIANG Yuanpu(The Third People′s Hospital of Chengdu,Chengdu 610000,Sichuan,China)
出处
《中西医结合心脑血管病杂志》
2024年第21期3984-3988,共5页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
关键词
脓毒性心肌病
左心室整体纵向应变
左室射血分数
预后
预测价值
sepsis-induced cardiomyopathy
left ventricular global longitudinal strain
left ventricular ejection fraction
prognosis
predictive value
