The Evaluation Of Troponin I In The Risk Stratification For Emergency Sepsis Patients

Objective: To observe the evaluation value of troponin I(cTnI)in the Risk Stratification for Emergency Sepsis PatientsMethods: Patients admitted to the emergency department of the First Affiliated Hospital of China Medical University from June 2021 to October 2022 who met the diagnostic criteria of sepsis 3.0 were systematically reviewed.Basic information,underlying diseases,infection sites,cTnI,brain natriuretic peptide(BNP),lactate value(Lac),procalcitonin(PCT),serum albumin(Alb),D-dimer,fibrinogen(Fg)within 24 hours after admission,complete echocardiographic ejection fraction within 3 days after admission,and sequential organ failure asses score(SOFA score)were collected.The primary outcome was the occurrence of death within 7 days,and the secondary outcome was septic shock or the need of organ support treatment.SPSS 22.0 software was used to compare the baseline data and laboratory results between the survival group and death group.Receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive ability of cTnI for outcome indicators,so as to explore the evaluation value of cTnI for risk stratification of sepsis patients.Results: A total of 115 patients meeting the criteria were included in this study,including87 patients in the survival group and 28 patients in the death group.The female mortality rate was higher than that of the male.The SOFA score,lactate value,cTnI,BNP and PCT levels in the death group were higher than those in the survival group,while the Alb level was lower than that in the survival group.There was no significant difference in other indicators.The results of multivariate Logistic regression analysis showed that,Lactic acid value [OR=1.207,95% CI(1.031,1.414),P=0.02],the SOFA score [OR=1.455,95% CI(1.158 1.828),P=0.001]and Log10 cTnI level [OR=2.489,95%CI(1.171-5.291),P=0.018] was an independent risk factor for 7-day mortality from sepsis.The area under ROC curve(AUROC)of SOFA score to predict mortality was 0.859(P<0.001),that of cTnI was 0.824(P<0.001),that of lactic acid value was 0.803(P<0.001),and that of the combined prediction of the three was 0.905.Echocardiographic findings showed that decreased ejection fraction and increased left ventricular end-diastolic diameter had no effect on mortality.In terms of other outcome indicators,the risk factor of needing mechanical ventilation within 7 days was SOFA score [OR=1.266,95%CI(1.074,1.492),P=0.005].The risk factors for sepsis shock were SOFA score [OR=1.551,95%CI(1.253-1.920),P < 0.001] and Log10 cTnI [OR=2.091,95%CI(1.041-4.203),P=0.038].Conclusion: The level of cTnI was independent predictors of 7-day mortality and septic shock in emergency patients with sepsis.In addition,SOFA score combined with cTnI and Lac can improve the predictive value of the single indicator for mortality,the cTnI level has reference significance for risk stratification in sepsis patients.