Clinical Study On The Diagnosis And Prognosis Prediction Of Sepsis Induced Cardiac Dysfunction

Objective:(1)The systematic evaluation prognostic value of myocardial fatty acid-binding protein(H-FABP)in patients with sepsis.(2)To explore the related risk factors for the patients with sepsis-induced cardiac dysfunction(SIMD)and predict the prognosis by combining predictive indication using logistic regression.(3)To investigate the risk factors of all-cause mortality in patients with sepsis and cardiac dysfunction.Methods:(1)Search Pubmed,Ovid,MEDLINE,Embase,Cochrane Library,CNKI Database,Wanfang Database,China Biomedical Literature Database to August 2017 Published Academic Papers,The search terms are limited to English and Chinese,excluding repetitive articles,screening based on inclusion and exclusion criteria,clinical studies meeting this META analysis,QUADAS quality assessment and data extraction,and META analysis using Rev man 5.3 software and Stata 10.0 software,To assess the relationship between H-FABP and the 28-day mortality at the primary outcome in sepsis;The relationship between H-FABP and secondary outcome vasoactive drug use,mechanical ventilation,and acute physiology and chronic health evaluation(APACHEⅡ)was evaluated.The statistical results were expressed as forest plots and the publication bias was tested using a funnel plot.(2)Analysis From August 2015 to August 2017,patients with sepsis and septic shock admitted to the Emergency Department,Emergency Intensive Care Unit,Intensive Care Unit and Respiratory Care Unit of the First Affiliated Hospital of Xinjiang Medical University,328 patients were diagnosed,patients with incomplete data records were excluded and 264 patients were finally included.According to the diagnostic criteria of heart failure by the European Heart Association,21 patients with ejection fraction reduction and 243 patients with ejection fraction normal,And then ejection fraction normal component of diastolic heart failure group of 66 patients and normal heart function group of 177 cases.The baseline data such as gender,age,ethnicity,systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,respiration rate,APACHEⅡscore,SOFA(Sequential organ failure assessment)score,andunderlying diseases were recorded within 24 hours of admission;meanwhile,the white blood cells,hemoglobin,platelets and average distribution width of platelets;myocardial markers creatine kinase(CK),creatinine kinase isoenzymes(CK-MB),troponin;NT-proBNP(N-terminal Prohormone of Brain Natriuretic Peptide),H-FABP;acute Inflammatory markers procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-9(IL-9),electrocardiogram(ECG)results,echocardiographic findings of left atrium(LA),right atrium(RA),left ventricular end-ejection fraction(EF),MV-E/A,E/e’value.The 28-day mortality and specific survival days were recorded.To compare the difference between indexes of diastolic heart dysfunction in EF reduction group and normal ejection fraction group;to compare the differences of each index between diastolic dysfunction group and normal cardiac function group;to compare the difference between cardiac dysfunction group and cardiac dysfunction.The differences between the indicators of normal group patients.Logistic multivariate analysis was used to analyze the statistic significance of cardiac dysfunction group,and the area under the curve(AUC),sensitivity and specificity were calculated by receiver operating characteristic curve(ROC)Regression formulation,significant indicators which come from multivariate regression will be assigned to diagnosis formulation.Then the diagnostic formulation was randomly selected from 80 patients for sampling to compare the presence or absence of sepsis-induced diastolic dysfunction to analyze the early diagnostic value of this model for sepsis-induced diastolic dysfunction and to calculate the sensitivity of the formulation,Specificity,positive likelihood ratio,negative likelihood ratio,diagnostic coincidence rate.(3)87 cases with cardiac dysfunction by sepsis and septic shock were enrolled from 2015.8-2017.8,of which 21 cases of EF decreased,EF normal group of 66 cases.The patients were divided into death group(56 cases)and survival group(31 cases)according to the death and survival outcome of 28 days.The records of gender,age,ethnicity,basic diseases,systolic blood pressure,diastolic blood pressure,mean artery pressure,heart rate,respiratory rate,The baseline data of acute physiology and chronic health evaluation(APACHE Ⅱ)score,SOFA score and MODS(Multiple organ dysfunction score)were recorded data within24 hours after admission.At the same time,the white blood cells,neutrophils,lymphocytes,hemoglobin,hematocrit,The mean distribution width,platelet and platelet distribution width;myocardial markers CK,CK-MB and troponin;heart failure markers NT-proBNP and H-FABP;Acute inflammation indicators of procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin-1β,interleukin-6,C-reactive protein(CRP);internationalstandardized ratio(INR)of coagulation function index,fibrinogen(FIB),partial coagulation Protonogen Time(APTT),Electrocardiogram(ECG)Results,Cardiac Ultrasound Left Atrial(LA),Right Atrial(RA),Left Ventricular Schwann,Right Ventricular,Ejection Fraction(EF),MV-E/A,E/e’ value;NT-proBNP,CK,CK-MB,Troponin-I(cTn-I),H-FABP.The COX-related risk factors were analyzed,there were statistically significant differences between the two groups between the death group and the survival group,and the 28-day mortality rate of septic patients with diastolic heart disease was compared with the univariate COX regression to the patient’s clinical outcomes.Whether death is the dependent variable,survival time as the time variable,univariate analysis,meaningful index as independent variables(age,mean arterial pressure,respiratory rate,blood lactat(Lac),prothrombin time,albumin,APACHEⅡscore,SOFA Score)Establish a regression model for COX regression analysis and statistical methods:Use SPSS 21.0 software to verify homogeneity of variance,measurement data t-test or rank sum test;count data using χ2 test,and perform statistically significant differences Factors and multi-factor COX regression and calculation of the survival function.Results:(1)There were 5 articles finally included in the study.There was no obvious publication bias in the included articles,including 587 patients,of which 205 were dead and 301 were H-FABP positive.The analysis showed that the 28-day mortality rate in H-FABP-positive group Significantly increased,the proportion of mechanical ventilation was significantly increased,the higher the critical score,the difference was statistically significant;vasoactive drug use was not significantly different;in predicting the 28-day mortality in septic patients,H-FABP positive The sensitivity and specificity were 82%and59%respectively.(2)ccording to the results,it can be seen that age,presence or absence of arrhythmia,systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,respiratory rate,hemoglobin,INR,partial thromboplastin time,blood lactate,interleukin-1β,interleukin-6,procalcitonin,NT-proBNP,and H-FABP were statistically different.Using logistic regression analysis of all statistically significant indicators of univariate and multivariate analysis showed that age,MAP,APTT,INR,NT-proBNP,H-FABP and arrhythmiawere statistically different.According to the logistic regression model,age,mean arterial pressure(MAP),NT-proBNP,H-FABP and SVT were fitted to form a new joint prediction factor to construct the receiver operating characteristic curve(ROC).Stata 10.0 software Statistical analysis and statistical mapping were performed to construct a diagnostic model of sepsis with cardiac dysfunction and to verify the diagnostic value of the model.(3)According to the results,we can see the age of deathgroup,underlying chronic obstructive pulmonary disease,systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,respiratory rate,mean platelet distribution width,hemoglobin,D-dimer,INR,partial prothrombin time,Blood lactate,GCS score APACHEII score,SOFA score,MODS score,TNF-α,IL-1β,IL-6,PCT,H-FABP,NT-proBNP,arrhythmia were all statistically different(P < 0.05).Univariate regression showed that The risk factors for death included age(RR: 1.017,95%CI:1.003-1.029),respiratory rate(RR: 1.056,95%CI: 1.028-1.084),and heart rate(RR: 1.017,95%CI: 1.007-1.027).,MODS(RR: 1.137,95%CI: 1.09-1.178),APACHE II score(RR:1.058,95%CI: 1.040,1.075),SOFA score(RR: 1.150,95%CI: 1.109,1.192),PCT(RR:1.007,95%CI: 1.002,1.013),IL-1β(RR: 1.034,95%CI: 1.005,1.064),TNF-α(RR: 1.056,95%CI: 1.006,1.079),IL-6(RR: 1.000,95%CI: 1.000,1.000),NT-proBNP(RR: 1.000,95%CI: 1.000,1.000),H-FABP(RR: 1.016,95%CI: 1.009-1.023),Lac(RR: 1.109,95%CI: 1.058,1.162),prothrombin time(RR: 1.108,95%CI: 1.006,1.029),INR(RR:1.346,95%CI: 1.159,1.565),APTT(RR: 1.028,95%CI: 1.018,1.039),Arrhythmia(RR:1.932,95%CI: 1.335,2.796).Among them,MAP(RR: 0.979,95%CI: 0.968-0.989),GCS(RR: 0.917,95%CI: 0.885,0.950),fibrinogen(RR: 0.855,95%CI: 0.771,0.948),RR<1,it is a protective factor.Multivariate COX regression showed that an independent risk factor for 28-day mortality in sepsis RR: 1.010,95%CI: 1.009-1.023,P < 0.05.At the same time,age(RR: 1.011,95%CI: 1.001-1.022),heart rate(RR: 1.017,95%CI:1.004-1.021),APACHE II score(RR: 1.031,95%CI: 1.010-1.054),H-FABP(RR: 1.010,95%CI: 1.009-1.023),APTT(RR: 1.013,95%CI: 1.011-1.025),Arrhythmia(RR: 1.875,95%CI: 1.415-2.686)were sepsis Individuals affected by 28-day death in patients with sexual dysfunction were age-independent.Among them,MAP(RR: 0.985,95%CI:0.975-0.996),fibrinogen(RR: 0.882,95%CI: 0.790-0.984),and RR<1 were protective factors.Age,heart rate,APACHE II score,H-FABP,APTT,and arrhythmia were independent risk factors affecting the prognosis of patients with sepsis.MAP and fibrinogen were protective factors that affected the prognosis of patients with sepsis.Conclusions:(1)H-FABP-positive sepsis patients are more exacerbated and H-FABP can be used as a biomarker for the 28-day mortality prediction in patients with severe sepsis and septic shock and is an independent prognostic factor for 28-day mortality.(2)Age,partial thromboplastin time,INR,NT-proBNP,H-FABP,arrhythmia were closely related to the diagnosis of sepsis with cardiac dysfunction.The combined predictors were better than those of each single indicator,and the sepsis Diagnosis of dysfunction syndrome has clinical value and significance.Multivariate regression analysis showed that there was nostatistical difference between IL-1β and IL-6.It had a certain diagnostic value for the cardiac dysfunction of sepsis,the significance of the diagnosis remains to be further explored.Arrhythmia is closely related to SIMD.(3)The age,heart rate,APACHEII score,H-FABP,APTT,and arrhythmia associated with death were closely related to sepsis-induced cardiac dysfunction,which can effectively predict 28-day mortality in patients with sepsis-induced cardiac dysfunction,in which fibrinogen can be used as the protective factors.Inflammatory factors IL-1β,TNF-α,IL-6 played a certain role in the promotion of sepsis and SIMD,but they can not be used as an independent risk factors for predicting SIMD.New-onset cardiac arrhythmias in SIMDpatients,especially new-onset atrial fibrillation,it was an independent risk factor for SIMD.