| Objective To detect early cardiac biomarkers in children with sepsis by point-of-care testing(POCT),and to explore its application value in determining myocardial injury and disease severity in sepsis,so as to provide a reliable basis for early identification and timely intervention of severe sepsis.Methods Single center prospective clinical study.Children with sepsis who were admitted to the PICU of Zibo Maternal and Child Health Hospital after January 2020 and met the inclusion criteria were selected as the research objects.Hospital records within 24 hours with general clinical data,including age,gender,the highest temperature,the source of infection,etc.,immediately after admission line bedside cardiac biomarkers,bedside echocardiography and electrocardiogram examination and routine blood,calcitonin original,arterial blood gas analysis and blood coagulation routine,biochemical and routine laboratory tests such as etiology.Pediatric critical illness score(PCIS)was used to evaluate the severity of sepsis in children within 24 hours after admission.Using troponin I > 0.15ng/ml as the diagnostic criteria for myocardial injury,children with sepsis who met the inclusion criteria were divided into septic myocardial injury group and nonmyocardial injury group.The patients were divided into septic shock group and sepsis group according to the clinical manifestations of sepsis and whether they were complicated with shock.SPSS26.0 statistical software was used to statistically process all the collected data.Results 1.A total of 96 children with sepsis were included in this study,including 47males(47/96,49.0%)and 49 females(49/96,51.0%)。The median age was 1 year and 4months.There was no significant difference in gender and age in this study.In this study,46 patients(46/96,47.9%)in the sepsis myocardial injury group and 50 patients(50/96,52.1%)in the non-myocardial injury group were included.There were 29 cases(29/96,30.2%)in septic shock group and 67 cases(67/96,69.8%)in non-shock group.2.The PCIS score of sepsis myocardial injury group was lower than that of non-myocardial injury group,and the difference was statistically significant(P < 0.05).The procalcitonin,hematocrit,lactate,D-dimer,alanine aminotransferase and ASpartate aminotransferase in the septic myocardial injury group were higher than those in the non-myocardial injury group,and the differences were statistically significant(P < 0.05).There was no significant difference between the two groups in the general clinical characteristics such as maximum body temperature,infection source and pathogenic bacteria within 24 hours after admission and the routine laboratory tests such as C-reactive protein,white blood cells,platelets and albumin(P > 0.05).3.Taking the myocardial injury in children with sepsis as the dependent variable,procalcitonin,hematoma,lactic acid,D-dimer,PCIS score,alanine aminotransferase and aspartate aminotransferase as the independent variables,multivariate binary Logistic regression analysis was performed,and it was found that lactic acid(OR=1.416,95%CI 1.059-1.894,P < 0.05)was used as the independent variable.P=0.019)and PCIS score(OR=0.883,95%CI 0.801-0.974,P=0.013)were independent risk factors for myocardial injury in sepsis.4.The median levels of creatine kinase isoenzyme(CK-MB),N-terminal pro-brain natriuretic peptide(NTpro BNP)and Myoglobin(Myoglobin)in septic myocardial injury group were higher than those in non-myocardial injury group,and the differences were statistically significant(P< 0.05).5.Correlation analysis of NT-Pro BNP,CK-MB,Myoglobin and CTn I in septic myocardial injury group showed that CK-MB(r=0.585,P =0.000)and NT-pro BNP(r=0.471,P =0.000)were significantly moderately positively correlated with c Tn I.There was a weak correlation between CK-MB and Myoglobin(r=0.289,P=0.004).CK-MB had the strongest correlation with CTn I,suggesting that CK-MB could be used as a basis for the diagnosis of myocardial injury in sepsis.6.In the septic myocardial injury group,20 cases(20/46,43.5%)had ST-T changes in ECG,while 12 cases(12/50,24.0%)in the non-myocardial injury group,and the difference was statistically significant(P=0.043),suggesting that ST-T changes in ECG of septic patients may be associated with myocardial injury.7.The left ventricular ejection fraction(LVEF)and left ventricular short-axis shortening rate(LVFS)in the septic myocardial injury group were lower than those in the non-myocardial injury group,but the differences were not statistically significant(P>0.05),suggesting that left ventricular systolic function measurement has certain limitations in the early diagnosis of septic myocardial injury.8.The median values of troponin I(c Tn I),creatine kinase isoenzyme(CK-MB),N-terminal pro-brain natriuretic peptide(NT-pro BNP)and Myoglobin(Myoglobin)in septic shock group were higher than those in sepsis group,and the differences were statistically significant(P <0.05).These results suggest that Myoglobin,CTn I,CK-MB and NT-pro BNP have potential in the diagnosis of septic shock.9.Binary Logistic multivariate risk factor analysis was performed with whether septic children were complicated with shock as the dependent variable and Myoglobin,CK-MB,c Tn I and NT-pro BNP as the independent variables,suggesting that NT-pro BNP was an independent risk factor for septic shock(OR=1.001,95%CI 1.001-1.002,P < 0.05).10.The Receiver Operating Characteristic(ROC)curve was used to evaluate the predictive ability of NT-pro BNP for septic shock,and the AUC of NT-pro BNP was calculated to be 0.925(95%CI: 87.1%-97.9%),according to the Yoden index,the best Cutoff value of NT-pro BNP for the diagnosis of septic shock was 3120.17pg/ml,with a sensitivity of 72.4% and a specificity of 99.7%.Conclusions 1.Lactate and PCIS score are independent risk factors for septic myocardial injury.Timely arterial blood gas analysis testing and pediatric critical case score for children with sepsis after admission can provide a clinical reference for the early identification of septic myocardial injury.2.Elevation of the early cardiac biomarker CKMB is strongly correlated with elevated c Tn I in children with sepsis.CK-MB can also be used as one of the important biomarkers for the diagnosis of myocardial injury in sepsis.3.NT-pro BNP has a good predictive value for the diagnosis of septic shock,with its optimal cut-off value(Cutoff)of 3120.17pg/ml,and its sensitivity and specificity of72.4% and 99.7%,respectively.. |
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