Clinical Study Of Prognosis And Related Risk Factors Of Patients With Sepsis-induced Myocardial Injury

Objective This study aimed to investigate the related risk factors affecting the occurrence and prognosis of sepsis-induced myocardial injury by analyzing the related clinical data of patients with sepsis-induced myocardial injury retrospectively.MethodsA total of 297 septic patients diagnosed by’SSC International Guideline 2016-Management of Sepsis and Septic Shock’in Emergency Department of Affiliated Hospital of Nan Tong University from January 2019 to December 2021 were participated in this study.The age,gender,basic disease,primary infection,days of admission to EICU,28-day prognosis,within 24 hours of admission APACHEII score and SOFA score,types of mechanical ventilation,vasoactive drugs,and hormone use were collected.We also recorded blood-related test indicators such as blood routine,liver function,renal function,electrolyte,coagulation image,blood gas analysis and other indicators.According to the presence or absence of myocardial injury,these septic patients were divided into 126 cases of myocardial injury group,including 77 males and 49 females,and 137 cases of non-myocardial injury group,including88 males and 49 females.The sepsis-induced myocardial injury group was further divided into the survival group（94 cases）and the death group（32 cases）according to whether survived on the 28th day of onset.By using univariate analysis and multivariate logistic regression analysis,we aimed to find the risk factors affecting myocardial injury and prognosis of sepsis,the predictive value was explored by ROC curve,and so as to screen out the relevant clinical indicators that can predict the prognosis and evaluate their predictive value.Results 1.There were statistically significant differences between sepsis-induced myocardial injury group and non-myocardial injury group in age,central nervous system infection,norepinephrine alone,norepinephrine combined with dobutamine,tracheal intubation,renal replacement therapy,laboratory examination indexes including c Tn I,CK-MB,Myo,NT-pro BNP,MCV,RDW,SD,AST,LDH,BUN,CR,UA,Na⁺,Cl^-,PT,APTT,INR,TT,HCO3^-,Beb,Beecf,Na⁺,Ca²⁺,Lac,buffer alkali,APACHE II,SOFA scores（p<0.05）.There was no statistical significance in other indicators（p>0.05）.Multivariate logistic analysis showed that there was no statistical significance in all aforementioned indexes（p>0.05）.2.Significant differences were found in the length of EICU stay,norepinephrine combined with dopamine,tracheal intubation,renal replacement therapy,DBIL,K⁺,PT,INR,ATIII,Lac,hemoglobin,APACHE II,SOFA score and high-sensitivity CRP between the death group and the survival group of sepsis-induced myocardial injury（p<0.05）.No statistical significance was found in other indicators（p>0.05）.Multivariate binary logistic regression analysis showed the length of EICU stay（OR=0.867,95%CI:0.784-0.958,p=0.005）,tracheal intubation（OR=11.192,95%CI:1.967-63.666,p=0.008）,SOFA score（OR=1.231,95%CI:1.010-1.500,p=0.039）,ATⅢ（OR=0.955,95%CI:0.916-0.996,p=0.030）were independent risk factors affecting the prognosis of patients with sepsis-induced myocardial injury.These independent risk factors strongly correlated with the prognosis of sepsis-induced myocardial injury patients by using receiver operating curve（ROC curve）analysis（p<0.05）.Conclusions1.The length of EICU hospital stay≥5.5 days,tracheal intubation,SOFA score≥9.5 scores and ATⅢ≤58.65s were independent risk factors for 28-day poor prognosis of patients with sepsis-induced myocardial injury.SOFA score had the strongest prediction efficiency,tracheal intubation had the weakest prediction efficiency,the length of EICU hospital stay had the highest specificity and lowest sensitivity.2.The combined prediction model composed of four independent risk factors of sepsis-induced myocardial injury patients demonstrates the highest sensitivity of tracheal intubation combined SOFA score and ATⅢ,the strongest prediction efficiency of tracheal intubation combined with the length of EICU hospital stay had a good application value in assessing the prognosis of sepsis-induced myocardial injury patients.