Analysis of incidence and related risk factors of septic cardiomyopathy

doi:10.3877/cma.j.issn.1674-6880.2022.03.001

Abstract

Abstract:

Objective

To investigate the incidence and related risk factors of septic cardiomyopathy (SCM).

Methods

A total of 228 patients with sepsis or septic shock admitted to ICU of Shaanxi Provincial People's Hospital from January 2019 to April 2021 were retrospectively analyzed in this study. All patients were divided into the SCM group (42 cases) and the non-SCM group (186 cases) according to the occurrence of SCM. The clinical indicators were recorded and compared between the two groups. The multivariate Logistic regression analysis was used to analyze the risk factors associated with the development of SCM. Meanwhile, the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each indicator on SCM occurrence.

Results

The incidence of SCM in patients with sepsis or septic shock was 18.4% (42/228). In the SCM group, the patients were older (t = 5.309, P<0.001), the incidences of coronary atherosclerotic heart disease (CHD), atrial fibrillation, heart failure and chronic kidney failure were higher (χ² = 5.090, P = 0.024; χ² = 6.399, P = 0.011; χ² = 31.848, P< 0.001; χ² = 3.979, P = 0.046), and the levels of white blood cell (WBC), lactate, creatine kinase isoenzymes-MB, high-sensitivity cardiac troponin T (hs-cTnT) and acute physiology and chronic health evaluation (APACHE) Ⅱ score (t = 4.560, P<0.001; Z = 3.855, P<0.001; Z = 2.075, P = 0.038; Z = 5.513, P<0.001; Z = 5.913, P<0.001) were all much higher than those in the non-SCM group. The multivariate Logistic regression analysis showed that the age [odds ratio (OR) = 1.071, 95% confidence interval (CI) (1.006, 1.139), P = 0.030], CHD [OR = 3.185, 95%CI (1.201, 8.447), P = 0.020], heart failure [OR = 3.028, 95%CI (1.041, 8.810), P = 0.042], WBC [OR = 1.095, 95%CI (1.003, 1.196), P = 0.042], lactate [OR = 1.095, 95%CI (1.014, 1.183), P = 0.021], hs-cTnT [OR = 1.629, 95%CI (1.098, 2.418), P = 0.015], APACHEⅡ score [OR = 1.092, 95%CI (1.003, 1.188), P = 0.043] were independent risk factors for the incidence of SCM. The ROC curve analysis showed that the age [area under the curve (AUC) = 0.767, 95%CI (0.694, 0.840), P<0.001], WBC [AUC = 0.757, 95%CI (0.689, 0.824), P<0.001], lactate [AUC = 0.690, 95%CI (0.603, 0.778), P<0.001], hs-cTnT [AUC = 0.772, 95%CI (0.071, 0.843), P<0.001] and APACHEⅡ score [AUC = 0.792, 95%CI (0.727, 0.856), P<0.001] all had certain predictive values for SCM occurrence.

Conclusions

The incidence of SCM of patients with sepsis or septic shock is relatively high. Age, CHD, heart failure, WBC, lactate, hs-cTnT and APACHEⅡ score are independent risk factors of SCM occurrence.

Key words: Cardiomyopathies, Sepsis, Shock, septic, Risk factors

Chan Wang, Boling Li, Xiaojuan Shi, Chengqiao Jing, Daoran Dong, Yuan Zong. Analysis of incidence and related risk factors of septic cardiomyopathy[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(03): 177-182.

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References 25

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组别	例数	年龄（岁）	男/女（例）	体质量（kg）	高血压[例（%）]	CHD[例（%）]	心房颤动[例（%）]	心力衰竭[例（%）]	糖尿病[例（%）]	脑梗死[例（%）]	慢性肾衰竭[例（%）]	恶性肿瘤[例（%）]
SCM组	42	78 ± 8	27/15	64 ± 7	11（26.2）	14（33.3）	13（31.0）	16（38.1）	7（16.7）	5（11.9）	8（19.0）	0（0）
非SCM组	186	67 ± 13	93/93	66 ± 10	55（29.6）	33（17.7）	27（14.5）	12（6.5）	39（21.0）	28（15.1）	14（7.5）	9（4.8）
t/χ²/Z值		5.309	2.805	1.439	0.190	5.090	6.399	31.848	0.394	0.274	3.979	1.032
P值		<0.001	0.094	0.219	0.663	0.024	0.011	<0.001	0.530	0.600	0.046	0.310
组别	例数	最高体温（℃）	心率（次/min）	呼吸频率（次/min）	MAP（mmHg）	WBC（×10⁹/L）	N（%）	RBC（×10¹²/L）	血红蛋白（g/L）	PLT（×10⁹/L）	降钙素原[μg/L，M（P₂₅，P₇₅）]
SCM组	42	37.6 ± 1.1	102 ± 35	24 ± 6	74 ± 17	21 ± 4	0.90 ± 0.05	3.2 ± 0.5	94 ± 15	104 ± 63	18（4，56）
非SCM组	186	37.9 ± 1.2	105 ± 33	25 ± 6	78 ± 19	17 ± 6	0.88 ± 0.07	3.1 ± 0.6	94 ± 21	113 ± 69	12（4，45）
t/χ²/Z值		1.870	0.466	0.423	1.274	4.560	1.468	0.828	0.097	0.776	0.837
P值		0.063	0.642	0.672	0.204	<0.001	0.144	0.411	0.923	0.438	0.403
组别	例数	hsCRP[mg/L，M（P₂₅，P₇₅）]	乳酸[mmol/L，M（P₂₅，P₇₅）]	CK-MB[μg/L，M（P₂₅，P₇₅）]	hs-cTnT[μg/L，M（P₂₅，P₇₅）]	肌红蛋白[μg/L，M（P₂₅，P₇₅）]	APACHEⅡ评分[分，M（P₂₅，P₇₅）]	SOFA评分[分，M（P₂₅，P₇₅）]
SCM组	42	1 042（792，1 631）	9.4（6.0，13.3）	42（18，65）	0.40（0.20，0.80）	120（27，657）	30（26，33）	12（10，16）
非SCM组	186	1 064（842，1 302）	4.5（2.3，8.8）	22（5，64）	0.11（0.03，0.28）	107（36，427）	21（17，27）	12（9，18）
t/χ²/Z值		0.544	3.855	2.075	5.513	0.141	5.913	0.382
P值		0.586	<0.001	0.038	<0.001	0.888	<0.001	0.702

组别	例数	年龄（岁）	男/女（例）	体质量（kg）	高血压[例（%）]	CHD[例（%）]	心房颤动[例（%）]	心力衰竭[例（%）]	糖尿病[例（%）]	脑梗死[例（%）]	慢性肾衰竭[例（%）]	恶性肿瘤[例（%）]
SCM组	42	78 ± 8	27/15	64 ± 7	11（26.2）	14（33.3）	13（31.0）	16（38.1）	7（16.7）	5（11.9）	8（19.0）	0（0）
非SCM组	186	67 ± 13	93/93	66 ± 10	55（29.6）	33（17.7）	27（14.5）	12（6.5）	39（21.0）	28（15.1）	14（7.5）	9（4.8）
t/χ²/Z值		5.309	2.805	1.439	0.190	5.090	6.399	31.848	0.394	0.274	3.979	1.032
P值		<0.001	0.094	0.219	0.663	0.024	0.011	<0.001	0.530	0.600	0.046	0.310
组别	例数	最高体温（℃）	心率（次/min）	呼吸频率（次/min）	MAP（mmHg）	WBC（×10⁹/L）	N（%）	RBC（×10¹²/L）	血红蛋白（g/L）	PLT（×10⁹/L）	降钙素原[μg/L，M（P₂₅，P₇₅）]
SCM组	42	37.6 ± 1.1	102 ± 35	24 ± 6	74 ± 17	21 ± 4	0.90 ± 0.05	3.2 ± 0.5	94 ± 15	104 ± 63	18（4，56）
非SCM组	186	37.9 ± 1.2	105 ± 33	25 ± 6	78 ± 19	17 ± 6	0.88 ± 0.07	3.1 ± 0.6	94 ± 21	113 ± 69	12（4，45）
t/χ²/Z值		1.870	0.466	0.423	1.274	4.560	1.468	0.828	0.097	0.776	0.837
P值		0.063	0.642	0.672	0.204	<0.001	0.144	0.411	0.923	0.438	0.403
组别	例数	hsCRP[mg/L，M（P₂₅，P₇₅）]	乳酸[mmol/L，M（P₂₅，P₇₅）]	CK-MB[μg/L，M（P₂₅，P₇₅）]	hs-cTnT[μg/L，M（P₂₅，P₇₅）]	肌红蛋白[μg/L，M（P₂₅，P₇₅）]	APACHEⅡ评分[分，M（P₂₅，P₇₅）]	SOFA评分[分，M（P₂₅，P₇₅）]
SCM组	42	1 042（792，1 631）	9.4（6.0，13.3）	42（18，65）	0.40（0.20，0.80）	120（27，657）	30（26，33）	12（10，16）
非SCM组	186	1 064（842，1 302）	4.5（2.3，8.8）	22（5，64）	0.11（0.03，0.28）	107（36，427）	21（17，27）	12（9，18）
t/χ²/Z值		0.544	3.855	2.075	5.513	0.141	5.913	0.382
P值		0.586	<0.001	0.038	<0.001	0.888	<0.001	0.702

因素	β值	标准误	Wald值	OR值	95%CI	P值
年龄（岁）	0.068	0.032	4.682	1.071	1.006 ~ 1.139	0.030
CHD	1.158	0.498	5.416	3.185	1.201 ~ 8.447	0.020
心房颤动	0.600	0.507	1.399	1.823	0.674 ~ 4.928	0.237
心力衰竭	1.108	0.545	4.137	3.028	1.041 ~ 8.810	0.042
慢性肾衰竭	-0.328	0.659	0.248	0.720	0.198 ~ 2.622	0.618
WBC（× 10⁹/L）	0.091	0.045	4.127	1.095	1.003 ~ 1.196	0.042
乳酸（mmol/L）	0.091	0.039	5.320	1.095	1.014 ~ 1.183	0.021
CK-MB（μg/L）	-0.003	0.004	0.368	0.997	0.989 ~ 1.006	0.544
hs-cTnT（μg/L）	0.488	0.201	5.870	1.629	1.098 ~ 2.418	0.015
APACHEⅡ评分（分）	0.088	0.043	4.103	1.092	1.003 ~ 1.188	0.043

因素	β值	标准误	Wald值	OR值	95%CI	P值
年龄（岁）	0.068	0.032	4.682	1.071	1.006 ~ 1.139	0.030
CHD	1.158	0.498	5.416	3.185	1.201 ~ 8.447	0.020
心房颤动	0.600	0.507	1.399	1.823	0.674 ~ 4.928	0.237
心力衰竭	1.108	0.545	4.137	3.028	1.041 ~ 8.810	0.042
慢性肾衰竭	-0.328	0.659	0.248	0.720	0.198 ~ 2.622	0.618
WBC（× 10⁹/L）	0.091	0.045	4.127	1.095	1.003 ~ 1.196	0.042
乳酸（mmol/L）	0.091	0.039	5.320	1.095	1.014 ~ 1.183	0.021
CK-MB（μg/L）	-0.003	0.004	0.368	0.997	0.989 ~ 1.006	0.544
hs-cTnT（μg/L）	0.488	0.201	5.870	1.629	1.098 ~ 2.418	0.015
APACHEⅡ评分（分）	0.088	0.043	4.103	1.092	1.003 ~ 1.188	0.043

指标	AUC	95%CI	P值	最大约登指数	敏感度	特异度
年龄（岁）	0.767	0.694 ~ 0.840	<0.001	0.461	0.929	0.532
WBC（× 10⁹/L）	0.757	0.689 ~ 0.824	<0.001	0.418	0.762	0.656
乳酸（mmol/L）	0.690	0.603 ~ 0.778	<0.001	0.369	0.762	0.608
hs-cTnT（μg/L）	0.772	0.071 ~ 0.843	<0.001	0.465	0.857	0.608
APACHEⅡ评分（分）	0.792	0.727 ~ 0.856	<0.001	0.466	0.762	0.704

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