Clinical Investigation On The Risk Factors For Prognosis In Patients With Septic Shock

Objective To study the risk factors of prognosis in patients with septic shock,and to provide a reliable evidence to evaluate severity.Methods A retrospective analysis was conducted.The data of 185 patients with septic shock,who admitted to the intensive care unit(ICU)of XX Hospital Affiliated to Anhui Medical University from Mar.2016 to Dec.2018,were enrolled.The blood routine test,blood biochemistry,blood gas analysis,myoglobin(Myo),cardiac troponin I(c Tn I),blood lactic acid(Lac),procalcitonin(PCT)and ratio of C-reactive protein and albumin(CRP/ALB)of patients on the day of septic shock diagnosed were collected.The Glasgow coma scale(GCS),quick sequential organ failure assessment(qSOFA),acute physiology and chronic health evaluationⅡ(APACHEⅡ)and multiple organ dysfunction syndrome(MODS)score as well as the time from hospitalization to septic shock and duration of mechanical ventilation were recorded.The patients were divided into death group and survival group according to whether they survived on 28days.According to Myo level,the patients were divided into two groups:Myo elevation group(Myo>98μg/L)and Myo normal group(Myo≤98μg/L).Patients with Myo elevation were divided into survival group and death group according to the prognosis of 28 days.The clinical data were compared among the groups,and the influencing factors of prognosis in the patients with septic shock were screened by multivariate Logistic regression analysis.Results 185 patients were enrolled in the final analysis,there were 106 deaths and79 survivors on 28 days,154 patients with elevated Myo and 31 patients with normal Myo.(1)Compared with the survival group,the death group had elder patients,faster heart rate,increased qSOFA,APACHEⅡ,MODS scores and blood Myo,Lac,PCT levels,decreased GCS score,and shorted time from hospitalization to septic shock and duration of mechanical ventilation(P<0.05).However,there was no significant difference in c Tn I or CRP/Alb between the two groups(P>0.05).Multivariate Logistic regression analysis showed that age[odds ratio(OR)=1.037,95%confidence interval(95%CI)=1.010-1.065,P=0.007],heart rate(OR=1.020,95%CI=1.003-1.037,P=0.023),qSOFA score(OR=2.839,95%CI=1.321-6.102,P=0.008),time from hospitalization to septic shock(OR=0.938,95%CI=0.898-0.980,P=0.004),duration of mechanical ventilation(OR=0.936,95%CI=0.899-0.975,P<0.001)and Myo(OR=1.492,95%CI=1.088～2.045,P=0.013)were independent risk factors for prognosis in the patients with septic shock.(2)Compared with the normal Myo group,the Myo elevation group had higher 28-day mortality[61.0%(94/154)vs.38.7%(12/31),χ~2=5.259,P=0.022].In the Myo elevation patients,compared with the survival group,the patients in death group were elder,and had higher PCT and qSOFA score,faster heart rate,lower GCS score,and shorter time from hospitalization to septic shock and duration of mechanical ventilation(P<0.05).But there was no significant difference in CRP/Alb between the two groups(P>0.05).Multivariate Logistic regression analysis showed that qSOFA score(OR=2.796,95%CI=1.270-6.153,P=0.011),time from hospitalization to septic shock(OR=0.925,95%CI=0.884-0.967,P=0.001)and duration of mechanical ventilation(OR=0.931,95%CI=0.884-0.980,P=0.006)were independent risk factors for the prognosis in the septic shock patients with blood Myo elevation.Conclusions Age,heart rate,qSOFA score,time from hospitalization to septic shock,duration of mechanical ventilation were independent risk factors for the prognosis of patients with septic shock.The 28-day mortality in patients with blood Myo elevation was significantly higher than that in those with normal blood Myo.The qSOFA score,time from hospitalization to septic shock and duration of mechanical ventilation were independent risk factors for the prognosis of septic shock patients with blood Myo elevation.