Clinical Characteristics And Prognosis Of Children With Sepsis Complicated With Myocardial Injury

Objective:To investigate the clinical features and prognostic factors of sepsis with myocardial injury in children.Methods:From January 2017 to January 2019 in Kunming Children's Hospital,138 children with sepsis complicated with myocardial injury were enrolled in the intensive care unit(PICU).Pediatric clinical illness score(PCIS),sex,age,infection site and clinical outcome were recorded at the time of admission,as well as whether trachea ventilator-assisted ventilation or blood purification therapy was used in the course of the disease.Sputum,blood,cerebrospinal fluid,urine or other secretions were collected for microbiological culture on the same day or the next morning,and the culture results were recorded.Venous blood samples were taken to detect creatine kinase(CK),creatine kinase isoenzyme(CK-MB),Myohemoglobin(Mb),high-Sensitivity cardiac troponin T(hs-cTnT)and procalcitonin(PCT),arterial blood gas analysis of lactic acid(Lac).The left ventricular ejection fraction(LVEF),cardiac output(CO),left ventricular truncation rate(LVFS)were recorded.were measured by echocardiography on the day of admission or the next day.echocardiography on the day of admission or the next day.According to the clinical results,the patients were divided into two groups:the improvement group(102 cases)and the deterioration group(36 cases),and the clinical data of each group were compared.and the survival rate of the patients was 28 days after automatic follow-up by telephone The subject operating curve(ROC curve)and multi-factor regression analysis was used to screen out the relevant clinical indexes which could predict the prognosis of childrenResults:The incidence of sepsis complicated with myocardial injury in intensive care unit of our hospital was 36.16%(158/437),and the 28-day mortality rate was 21.7%(30/138).The primary infection site of sepsis with myocardial injury in ICU of our hospital was respiratory tract(61 cases 44.2%),49 cases(35.5%)were complicated with multi-system infection,67 cases of 138 cases were positive,the main pathogenic bacteria were virus and Gram-negative bacteria,EB virus was dominant in virus(14 cases 20.8%)and Escherichia coli was dominant in Gram-negative bacteria(11 cases 16.4%).There were 20 cases with infection of two or more pathogens.Myocardial markers in children with sepsis and myocardial injury:CK(>211.5U/L)in 118cases(85.5%),Mb elevated(>72ng/ml)in 112cases(81%),CK-MB elevated in 101cases(>80U/L)(73%).Hs-cTnT increased(>24.9 pg/ml)in 98 cases(71%).It was suggested that high-sensitivity cardiac troponin T and lactic acid were the risk factors for predicting the clinical prognosis of the children after the data analysis of the improved group and the malignant group.The levels of creatine kinase,creatine kinase isoenzyme,myohemoglobin,calcitonin,left ventricular ejection fraction,cardiac outout and left ventricular fractional shortening in children with sepsis and myocardial injury were not significantly predictive for clinical prognosis.After ROC curve analysis,it was suggested that high-sensitivity cardiac troponin T(hs-cTnT)has the highest value in predicting the clinical outcome of children.The critical point is hs-cTnT>159.59pg/ml,which is sensitive and sensitive.The degree was 36.1%and the specificity was 98.2%.Logistic regression analysis.showed that high-sensitivity cardiac troponin T and sex were independent risk factors for prognosis.Conclusions:1.The incidence of sepsis complicated with myocardial injury in intensive care unit of our hospital was 36.16%,and the 28-day mortality rate was 21.7%.The primary infection site was mainly respiratory tract and the main pathogenic bacteria were EB virus and Escherichia coli.2.The elevated level of high-sensitivity cardiac troponin T and lactic acid suggested that the prognosis of children with sepsis complicated with myocardial injury was poor.The specificity is high,but the sensitivity was not high.3.High-sensitivity cardiac troponin T and sex were independent risk factors for prognosis,the reasons need to be further studied.4.The levels of creatine kinase,creatine kinase isoenzyme,myohemoglobin,calcitonin,left ventricular ejection fraction,cardiac output and left ventricular fractional shortening in children with sepsis and myocardial injury were not significantly predictive for clinical prognosis.