Prediction Value Of Afterload-related Cardiac Performance In Prognosis Of Patients With Sepsis

Objective:Low systemic vascular resistance（SVR）due to sepsis may lead to a compensatory increase in cardiac output（CO）,which in turn leads to a pseudo normalization of cardiac output.Studies have shown that the index of afterload-related cardiac performance（ACP）can measure whether the increased CO matches a specific SVR.This study aims to investigate whether ACP can more effectively evaluate the cardiac function status and predict the prognosis of septic patients compared with CO,cardiac index（CI）and cardiac power index（CPI）.Methods:This study was a single-center prospective study with continuous inclusion of septic patients who met the sepsis3.0 diagnostic criteria.The patients were admitted to the intensive care unit of the Fourth Hospital of Hebei Medical University from October 1,2018 to January 31,2019.Record basic medical characteristics.Detect CO with the first（D₁）and the third 24h（D₃）after admission through transthoracic echocardiography.MAP and CVP were recorded,ACP,CI and CPI were calculated,and then the correlation between these cardiac function indicators and the severity and prognosis of septic patients was analyzed,as well as predict the 28-day mortality of patients.Results:1.The inclusion process and groups in this studyA total of 41 patients with sepsis were selected for data analysis.Patients were divided into survival group（n=27）and non-survival group（n=14）according to their survival status on day 28.In addition to critical disease score,CRP,CVP and lactic acid,there were no statistical differences in other basic medical characteristics between the two groups.2.Comparison of CO,CI,CPI and ACP between survival group and non-survival groupCompared with the survival group,ACP（%）in the non-survival group decreased significantly（D₁:87.4±12.5 vs 74.2±11.5,P=0.002）;D₃:90.7±8.8vs 64.3±12.1,P<0.001).In addition,CO,CI and CPI in non-survival group were significantly lower than those in the survival group,with statistically significant differences（P<0.05）.3.Correlation analysis between CO,CI,CPI,ACP and critical illness scoreThere were no significant correlation between CO and critical illness score with 0-24h after inclusion（D₁）（P>0.05）.However,CO had negative correlation（P<0.05）with critical illness score after 48-72h of inclusion（D₃）.Other three heart function indexs:CI（D₁:r=-0.353,D₃:r=-0.386）,CPI（D₁:r=-0.335,D₃:r=-0.43）,ACP（D₁:r=-0.324,D₃:r=-0.397）,have significantly negative correlation（P<0.05）with APACHEⅡscore.Similarly,CI（D₁:r=-0.346,D₃:r=-0.466）,CPI（D₁:r=-0.381,D₃:r=-0.466）,ACP（D₁:r=-0.374,D₃:r=-0.553）are all negatively correlated with SOFA score（P<0.05）.4.Classification of cardiac function injury in survival group and non-survival groupPatients with sepsis in survival group and non-survival group were graded for cardiac function according to ACP standards.The results showed that a small number of patients in the survival group（D₁:29.63%,D₃:14.81%）had cardiac function injury（ACP≤80%）.The majority of patients in non-survival group（D₁:79.57%,D₃:85.71%）showed early cardiac function impairment.5.The predictive value of ACP,CI and CPI on 28-day mortality of patients with sepsisFor 0-24 hours after admission,the area under the ROC curve（AUC）predicted by ACP,CI and CPI for 28-day mortality was 0.775（95%CI,0.618-0.890;P<0.001）,0.717（95%CI,0.555-0.846;P=0.015）,0.741（95%CI,0.680-0.865;P=0.004）.Within 48-72 hours after admission,the AUC predicted by ACP,CI and CPI for 28-day mortality were 0.976（95%CI,0.872-0.999;P<0.001）,0.717（95%CI,0.681-0.929）;P=0.015),0.741（95%CI,0.779-0.977;P=0.004）.Compared with CI and CPI,ACP’s forecast accuracy is higher.The ACP’s critical values for predicting 28-day survival state in septic patients were 80%（D₁）and 78%（D₃）,respectively.Conclusions:ACP can be used to evaluate the cardiac function status of patients with sepsis,which is negatively correlated with the degree of disease severity of patients.ACP’s sensitivity and specificity of the prediction of28-day mortality were relatively high.Especially during the 48-72 hours after admission,compared with the traditional cardiac function indicators such as CI and CPI,ACP has better predictive value.