Analysis Of Risk Factors And Clinical Features In Patients With Heart Injury In Sepsis

Purpose The clinical characteristics and risk factors of sepsis related cardiac injury were studied in sepsis cases,so as to provide evidence for early diagnosis and treatment of sepsis related cardiac injury and to reduce mortality.Methods Retrospective analysis was performed on patients who met the diagnostic criteria defined in the third edition of the definition of sepsis among the patients admitted to the intensive care unit(ICU)of the second hospital of medical university from January 2018 to November 2019.The collected patients with sepsis were divided into the cardiac injury group and the non-cardiac injury group according to the presence or absence of sepsis related cardiac injury,and the cardiac injury group was divided into the survival group and the death group according to the prognosis of the patients.After collecting relevant clinical data,statistical analysis software was used to compare the differences between groups and analyze the clinical features of cardiac injury in sepsis as well as the independent risk factors affecting disease and prognosis.Results A total of 206 cases were included in the study.According to the diagnostic criteria,the patients were divided into the heart injury group(n=90)and the non-heart injury group(n=116),with 59 males in the heart injury group accounting for 65.6%and 67 males in the non-heart injury group accounting for 57.8%.Patients with sepsis heart injury were divided into the death group(n=41)and the survival group(n=49)according to the prognosis.The 28-day fatality rate was 35.4% in sepsis patients,45.6% in the heart injury group and 27.6% in the non-heart injury group.According to the disease diagnosis and statistics of the infection sites in the heart injury group,among them,lung infection(57 cases)accounted for 63.3%,abdominal infection(18 cases)accounted for 20.0%,urinary tract infection(6 cases)accounted for 6.7%,intracranial infection(3 cases)accounted for 3.3%,blood infection(2 cases)accounted for 2.2%,and other(4 cases)accounted for 4.4%.The distribution of infection sites was not significantly different from that of the non-heart injury group.According to the statistics of positive results of pathogen culture,52.5% of the culture results in the heart injury group were gram-negative bacteria(31 cases),42.4% were gram-positive bacteria(25 cases),and 5.1% were fungi(3 cases).The results are similar to the total culture results.Heart injury group and non cardiac injury during mechanical ventilation,the prognosis,APACHE Ⅱ grade,SOFA,Cr,AST,mean arterial pressure,CKMB,BNP,PCT,Na,etc have statistical difference(P < 0.5).Single factor Logistic regression analysis showed that: the APACHE Ⅱ grade,SOFA,mechanical ventilation,mean arterial pressure,the BNP,PCT,Na,statistically significant(P < 0.5).Multiariable Logistic regression analysis,the result shows: the APACHE Ⅱ score(OR: 1.016,95% CI: 0.932 1.042,P = 0.009),the SOFA score(OR: 1.190,95% CI: 1.160 1.211,P< 0.001),and mechanical ventilation(OR: 1.355,95% CI: 0.549 3.341,P = 0.010),mean arterial pressure(OR: 1.377,95% CI,1.029 1.461,P = 0.033),BNP(OR:1.036,95%ci: 1.001-1.048,P=0.016),and PCT(OR: 1.012,95%ci: 0.997-1.027,P=0.013)showed statistical differences.Sepsis heart damage survival group and death group,two groups of hypertension,mechanical ventilation,positive myodynamia,APACHE Ⅱ grade,SOFA,Lac,Glu,AST,HR,mean arterial pressure,systolic blood pressure,the BNP index difference was statistically significant(P < 0.5).Single factor Logistic regression analysis showed that: the APACHE Ⅱ grade,SOFA,history of hypertension,mechanical ventilation,Glu,AST,HR,mean arterial pressure,systolic blood pressure,the BNP,positive inotropic drugs,statistically significant(P < 0.5).Multivariate Logistic regression analysis showed that SOFA score(OR: 1.150,95%ci: 1.108-1.193,P=0.001),Glu(OR: 1.329,95%ci: 1.080-1.635,P=0.007),mean arterial pressure(OR:1.286,95%ci: 0.976-1.397,P=0.008),BNP(OR: 1.098,95%ci: 1.013-1.110,P=0.014)showed statistical differences.Conclusion Sepsis cardiac injury is one of the common serious complications in ICU patients with sepsis and one of the common fatal diseases in intensive care units.In this study,the case fatality rate of patients with sepsis was 35.4%,and that of patients with complicated heart injury was 45.6%.The most common site of infection in patients with sepsis and heart injury was pulmonary infection,followed by abdominal infection.The most common pathogenic agents were gram-negative bacteria,followed by gram-positive bacteria.APACHE Ⅱ grade,SOFA,mechanical ventilation,mean arterial pressure,PCT is sepsis relative independent risk factors for heart injury illness;SOFA score,Glu,and mean arterial pressure are independent risk factors for sepsis related cardiac injury and death.