A Single-center PSM Case-control Study Of Prognostic Risk Factors For Septic Shock In Children With Cardiomyopathy

Objective:Septic shock is one of the most common critical diseases in children,and its morbidity and mortality are high.the aim of this study was to explore prognostic risk factors for septic shock with cardiomyopathy.Methods:This study uses a single center,Retrospective,Based on a PSM case-control study,From January 1,2015 to March 1,2021,the children with septic shock who were hospitalized in the Children’s intensive Care Unit(PICU)of the affiliated Children’s Hospital of Chongqing Medical University were selected as the experimental objects;Screening of children with septic shock with cardiomyopathy(SICM)as SICM group,Using propensity score matching,age,sex,pediatric critical case score(PCIS),history of underlying disease as matching factors,A 1:2 ratio of non-cardiac myopathy patients with septic shock was used to match the non-cardiac myopathy group of septic shock(SICM group);On the basis of 28 days of illness in both SICM and non SICM groups,It is divided into survival group and death group;Get the clinical data,Statistical analysis of mortality,clinical characteristics,risk factors and so on.Results:A total of 138 cases of septic shock were included in this study,Of these,46 were septic shock with cardiomyopathy,92 cases were septic shock non-cardiac myopathy;Of the 45 deaths,93 cases were survival group.Survival analysis suggests that septic cardiomyopathy is not a risk factor for 28 days mortality in septic shock(p=0.231).COX regression analysis showed PICU mortality(OR 1.010;)between troponin I and septic shock 95%CI 1.004～1.008)and 28 days case fatality rate(OR 1.009;);and 95%CI 1.003～1.015),The partial regression coefficients were 0.010 and 0.009,suggesting that troponin I is a risk factor for septic shock death.Multivariate logistic regression analysis showed that LVEF、cTnI、CKMB、BNP、FS、E/A、ST was associated with the prognosis of septic shock;COX regression analysis did not suggest a correlation between cTnI、CKMB、BNP and the duration of hospitalization for septic shock,invasive ventilator use and ICU hospitalization;The scatter plot did not find any correlation between LVEF、cTnI、CKMB、BNP、FS、E/A、ST and hospitalization time of septic shock,invasive ventilator use time and ICU hospitalization time.MAPmin(OR 0.879);95%CI 0.821～0.940)is an independent risk factor for PICU mortality in children with septic shock.ROC curve analysis showed that the area under the curve for predicting PICU death in children with septic shock was 0.966,0.918,0.762,MAPmin、survival time,ICU hospitalization time,total hospitalization time were 0.714,0.992,0.723,0.866,respectively.Conclusion:MAPmin and troponin I are risk factors affecting the prognosis of children with septic shock.The total hospitalization time of children with septic shock was positively correlated with MAPmin and negatively correlated with lactic acid;ICU hospitalization time was positively correlated with PCIS score and negatively correlated with VIS score;and the use time of invasive ventilator was negatively correlated with lactic acid.LVEF and myocardial markers(cTnI、CKMB、BNP)are not risk factors for the prognosis of septic shock,and have no correlation with invasive ventilator installation time,PICU hospitalization time and total hospitalization time of septic shock.The data showed that septic cardiomyopathy was not a risk factor for the prognosis of children with septic shock.