The Research On The Relationship Between Myocardial Injury Markers And Etiological Types And Prognosis In Patients With Bloodstream Infectious Sepsis

Objective:To explore the correlation between the level of myocardial injury markers and etiological types and prognosis in Intensive Care Unit(ICU)with hemodynamic infectious sepsis,so as to provide reference for the diagnosis,treatment and prognosis assessment of sepsis myocardial injury.Methods:From October 1,2017 to February 28,2019,169 patients who were admitted to the intensive care unit of the First Affiliated Hospital of Guangxi Medical University for positive blood culture and diagnosis of sepsis were analyzed retrospectively.According to the inclusion and exclusion criteria,98patients were finally included.According to the results of blood culture,sepsis patients were divided into three groups:Gram-positive bacteria group(32 cases),Gram-negative bacteria group(57 cases)and fungus group(9 cases);patients were divided into survival group(59 cases)and death group(39 cases)according to the survival condition within 28 days.Baseline data(gender,age,number of days in ICU,previous basic diseases,Primary infection site m,outcome within 28days,cause of death),acute physical and chronic health evaluation Ⅱ(APACHE-Ⅱ),sequential organ failure assessment were collected,SOFA),N-terminal pro-B natriuretic titanium(NT pro BNP),serum troponin I(cTnI),serum procalcitonin(PCT),blood pathogen culture results,shock,multiple organ dysfunction syndrome,MODS),to compare the difference of myocardial injury markers in different pathogens of sepsis patients with positive blood culture and analyze the relationship between them and prognosis.Results:1.Among the 98 patients in this study,59 were male(60.20%)and39 were female(39.8%),with an average age of(54.01±15.81),an average ICUn(9.2%),13 cases of diabetes(13.3%),56 cases of shock(57.1%),40 cases of MODS(40.8%);57cases of G-bacteria(58.2%),32 cases of G+bacteria(32.7%),fungi 9 cases(9.1%);42 cases(42.9%)in normal myocardium group and 56 cases(57.1%)in myocardial injury;39 deaths(39.8%)in total deaths,including 25 deaths(43.9%)in G~-bacteria group;11 cases(34.4%)died in the G~+bacteria group;3 cases(33.3%)died in the fungus group;20 cases(51.3%)in the circulatory system,12cases(30.8%)in the respiratory system,and 4 cases(10.3%)in the central nervous system),3 cases(7.7%)for other reasons;Primary infection sites showed:48cases of lung infection(49%),22 cases of abdominal infection(22.4%),10 cases of urinary tract infection(10.2%),5 cases of skin and soft tissue infection(5.1%),and 6 cases of wound infection(6.1%),7 cases of other infections(7.1%).2.The level of NT pro BNP was(3725.61±8450.20;10715.06±13190.39);10687.28±14246.21,P=0.029),with statistical significance(P<0.05);comparison within the group showed that the difference mainly existed in G~-bacteria and G~+bacteria,and NT pro BNP of G~-bacteria was significantly higher than that of G~+bacteria,with statistical significance(P<0.05);in G~-bacteria group,Acinetobacter baumannii and Klebsiella pneumoniae had statistical significance(P<0.05),Klebsiella pneumoniae had statistical significance(P<0.05)There was no significant difference in serum cTnI among different pathogens(P>0.05).3.Compared with the survival group,the death group’s age,number of days in ICU,APACHE-Ⅱ,SOFA,PCT,NT-Pro BNP,cTnI,PCT,NT-Pro BNP,and cTnI were significantly higher than the survival group(20.67±9.612 VS 14.93±6.82;8.85±3.97 VS 6.54±3.06;16.67[(2.52,43.72)]VS 2.94[(0.573,21.24)];4265[(1253,23258)]VS 1350[(322.6,6574)];0.066[(0.022,0.479)]VS0.033[(0.011,0.098)]),all had statistical significance(P<0.05);shock had difference in the two groups(P=0.037),all related to death,with statistical significance(P<0.05);logistic regression analysis showed that age,days in ICU,SOFA score,shock were independent risk factors for predicting death within 28days of sepsis(P=0.015,OR=1.273,95%CI:1.047-1.548;P=0.029,OR=0.396,95%CI:0.173-0.910)。4.When predicting death,the areas under the ROC curve of NT-Pro BNP and cTnI were 0.664 and 0.621,respectively,with statistical significance,When the cutoff value of NT-Pro BNP is 1083.5pg/ml,the sensitivity and specificity are 92.3%and61%respectively;when the cutoff value of cTnI is 0.056ng/ml,the sensitivity and specificity are 84.6%,62.7%.Bivariate correlation analysis showed that NT-pro BNP was positively correlated with APACHE-Ⅱ,SOFA,and PCT(P<0.05),and cTnI was positively correlated with PCT(P<0.05).Conclusions:Compared with G~+bacteria and fungi,myocardial damage is most obvious in sepsis patients infected with G~-bacteria,and the levels of NT-Pro BNP in different G~-bacteria vary;serum NT-Pro BNP and cTnI levels are elevated and those in sepsis28 Death was positively correlated within days.