Clinical Study On Myocardial Injury In Children With Sepsis

Objective:To know about the incidence of myocardial injury in children with sepsis. Explore the relationship between cardiac markers (cTnI,CK-MB) and inflammatory markers (CRP,PCT), and the role they played to asess the severity of disease and prognosis, to provide the guidance for early treatment.Methods:Retrospective study of 185 children with sepsis in Children’s Hospital of Chongqing Medical University from July 2013 to December 2014. Divide the patients into 3 groups according to the severity of the disease:sepsis group (82 cases), severe sepsis group (49 cases) and septic shock group (54 cases). Compare the differences between the groups in clinical indicators. Detect the serum cTnI, CK-MB, CRP and PCT level within 24 hours of admission, to know about the incidence of myocardial injury. Compare the abnormal myocardial markers group with the normal myocardial markers group in clinical indicators. Analyse the correlation between cTnI, CK-MB and CRP, PCT, and their impact on disease severity and prognosis.Results:The incidence of myocardial injury in children with sepsis is 55.14%(102/185 cases), and the infants group has the highest incidence rate of myocardial injury(62.62%). Children with primary infection of the digestive system have high myocardial injury incidence rate of 69.23%. With the aggravation of the disease, the ICU hospitalization days, positive rate of myocardial markers, motality and serum cTnI, CK-MB, PCT levels are significantly increased according to the order of sepsis group, severe sepsis group and septic shock group(P<0.05). The positive rate of ECG, positive rate of UCG and serum CRP level exist no significantly difference between severe sepsis group and septic shock group(P>0.05), but significantly higher than the sepsis group(P<0.05). The ICU hospitalization days, positive rate of ECG, positive rate of UCG, incidence rate of severe sepsis or septic shock and motality are significantly different between abnormal myocardial markers group and normal myocardial markers group, as well as the "both cTnI and CK-MB elevated" group and "cTnI elevated" group or "CK-MB elevated" group(P<0.05), but not different between "cTnI elevated" group or "CK-MB elevated" group(P>0.05). According to the area under the ROC curve, various indicators to assess the severity of sepsis in descending order is PCT(0.652)、CK-MB(0.640)、cTnI(0.634)、 CRP(0.554). Serum cTnI, CK-MB levels showed a significant positive correlation with serum CRP and PCT levels, but a significant negative correlation with prognosis. Combined detection of cTnI and CK-MB has more significance for prognosis.Conclusion:There is high incidence of myocardial injury in children with sepsis, and more common in babies under 1 year old and primary digestive infections. The incidence of myocardial injury increased with the sicker of sepsis. Serum cTnI and CK-MB levels have important implications for the early diagnosis of sepsis in children with myocardial injury, superior to ECG and UCG. Children with elevated cTnl and CK-MB are sicker and have higher motality. Combined detection of serum CRP and PCT levels contribute to predict the severity of the disease and the extent of myocardial injury. Serum cTnI and CK-MB play an important role to forecast the myocaridal injury and prognosis in children with sepsis.