Investigate The Diagnostic Value Of Echocardiography Combined With Cardiac Markers In Patients With Sepsis-Induced Cardiac Dysfunction

Objective: 1.To observe and compare the changes of echocardiographic data and cardiac markers in two groups of patients who with sepsis-induced myocardial dysfunction or only sepsis.2.To investigate the diagnostic value of echocardiography combined with cardiac markers in patients with sepsis-induced myocardial dysfunction.Methods: A prospective clinical observational study was conducted.Collection of 80 patients who were admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Shihezi University were selected as sepsis group,and 30 healthy subjects were selected as control group.The general data of all the patients were recorded.The patients in the sepsis group underwent cardiac ultrasound at 1 day,3 days,7 days,and 10 days after diagnosed.The control group perfected echocardiography on the day of physical examination.Both groups were examined at the First Affiliated Hospital of Shihezi University on the day of examination.The department completed the relevant examination and took 5 ml of venous blood.All collected venous blood was centrifuged at 3500r/min for 10 min,and the superabundant was taken,numbered and stored in the-80°C refrigerator for testing.The concentration of GPBB and H-FABP in serum was determined by ELISA.The sepsis group was divided into sepsis-induced cardiac dysfunction group and sepsis without myocardial dysfunction group according to whether or not cardiac dysfunction occurred.Data of echocardiography and cardiac markers were statistically analyzed,and judged according to epidemiological methods combined with clinical knowledge.Evaluate the significance of the joint diagnostic test.Results: Compared with the control group,the echocardiography,cardiac markers,and laboratory tests were different in the sepsis group,and the difference was statistically significant(P<0.05).The sepsis heart function normal group and the sepsis heart dysfunction group The basic data of the two groups were comparable(P<0.05);the APACHE II score,SOFA score,hospitalization time,and 28-day mortality rate in the sepsis heart failure group were higher than those in the normal sepsis heart function group,except for the SOFA score.The difference was statistically significant(P>0.05),and the difference was not statistically significant(P<0.05).The patients with sepsis heart failure and normal heart function were analyzed by repeated measures analysis of variance: no consideration was given to grouping: WBC,N%,CK-MB,and H-FABP were statistically different at different time points(P<0.05);no time was considered: N%,CK-MB,GPBB,and H-FABP groups had the same difference at the same time point.Statistical significance(P<0.05),there was no significant difference in WBC between the different groups(P>0.05).There was no interaction between WBC,N%,GPBB and H-FABP time and group(P<0.05);PCT and NT-proBNP time and group interaction,different groups,different time,and difference were statistically significant(P <0.05).cTnI was higher than sepsis in different groups and at different time points.The difference was not statistically significant,and there was no interaction between time and group(P>0.05).The echocardiographic parameters of the two groups were analyzed by repeated measures of variance: no grouping factors were considered: all indicators were significantly different at different time points(P<0.05);time factors were not considered: EDV,ESV,EF,SV,CO,FS,EPSS,IVRT,EDT,Ad,S,D,E’,A’,Sm,PVBV were significantly different among different groups(P<0.05),while E,A,E/A,S /D was not significantly different between the two groups(P>0.05);EDV,ESV,CO,EF,EPSS,A,IVRT,EDT,Ad,S,D,S/D,E’,A’,Both Sm and PVBV had interaction time with the group(P>0.05),while SV,FS,E,E/A time had no interaction with the group(P>0.05).Logistic regression analysis showed that the main factors affecting the occurrence of sepsis cardiac dysfunction were: EDV,SV,EF,CO,FS,IVRT,A’,Sm,NT-proBNP,N%.The ROC curve analysis was carried out on the selected indicators,and the area under the ROC curve was compared.The area under the ROC curve was: NT-proBNP(0.915),A’(0.908)> SV(0.779),IVRT(0.775).EF(0.753),CO(0.754)> Sm(0.738),FS(0.728)> EDV(0.636).Logistic regression analysis of 28-day mortality in patients with sepsis showed that only A,CK-MB,H-FABP,and cardiac insufficiency were associated with short-term prognosis.ROC curve analysis showed that only H-FABP area under the curve was significant(P < 0.05).H-FABP> 35.7 ng/ml can predict poor prognosis in patients with sepsis.In the joint diagnostic tests for sepsis cardiac dysfunction,when NT-proBNP and A’ were tested in series,the positive likelihood ratio was the highest in all joint diagnostic tests,80.1,sensitivity was 78.53%,specificity was 99.02%,positive predictive value was 99.29%,negative predictive value was 72.66% and the agreement rate was 86.02%.When NT-proBNP,A’ and SV were tested in parallel,the negative likelihood ratio was the smallest in each joint diagnostic test,with a sensitivity of 99.44%,a specificity of 69.61%,and a positive predictive value of 85.02%.Negative predictive value was 98.61% and the agreement rate was 88.53%.Conclusion: 1.Patients with cardiac insufficiency in the course of sepsis are prone to cardiac imaging changes on the 7th to 10 th day;2.H-FABP can be used as a predictor of poor prognosis in patients with sepsis;3.NT-proBNP,A’ series of tests can be used as a diagnostic test for sepsis cardiac dysfunction;4.Parallel testing of NT-proBNP,A’,and SV can be used as a diagnostic test to exclude sepsis cardiac dysfunction.