Analysis Of Related Risk Factors Associated With Sepsis Cardiomyopathy After Surgery In Patients With Sepsis

Objective By retrospective analysis of medical history of sepsis patients,this multi-center clinical study was to identify relevant risk factors of sepsis cardiomyopathy(SCM)in 48 hours after admission to intensive care unit(ICU).We also aimed to provide reference for identifing high-risk groups in advance,so that the perioperative management quality of critically ill patients can be improved.Six centers participated in this study,including Second Affiliated Hospital of Soochow University,the First Affiliated Hospital of Soochow University,the Head Office,the East District and the North District of Suzhou Municipal Hospital,the 9th People’s Hospital of Suzhou.Patients who were diagnosed with sepsis during the perioperative period and admitted to ICU after surgery from January 2017 to November 2020 were enrolled.Perioperative data were analyzed retrospectively.Collected and analyzed the following patients’ information:(1)General information:age,weight,height,gender,body mass index(BMI),date of diabetes,hypertension,and receiving method;(2)Surgery-related information:preoperative shock,whether emergency operation,whether endoscopic surgery and surgical site;(3)ICU condition:postoperative sequential organ failure(SOFA)score,initial blood lactic acid value,maximum blood lactic acid value,initial platelet count,minimum platelet count,maximum procalcitonin(PCT)value,maximum body temperature,maximum noradrenaline maintenance dose;(4)Whether SCM occurred within 48 hours after admission to ICU;(5)Postoperative ICU stay with mechanical ventilation,duration of mechanical ventilation,tracheotomy,continuous renal replacement therapy,death,mean ICU stay,and total hospitalization cost.Patients were divided into septic cardiomyopathy group(SCM group)and non-septic cardiomyopathy group(NSCM group)according to whether they had SCM within 48 hours after admission to ICU.Parameters were compared between groups and factors with P<0.1 were analysed with multivariate Logistic regression,screening the risk factors for SCM.The area under receiver operating characteristic(AUC)curve was used to assess the discriminative capacity of the model.Used to evaluate the calibration capability of the model,using the HosmerLemeshow correlation test.Results:A total of 300 cases were included in this study,including 53 cases of SCM.Multivariate analysis results showed that SOFA score[adjusted odds ratio(aOR)=1.449,95%confidence interval(CI):1.210-1.735,P=0.000]and endoscopic surgery(aOR=3.358,95%CI:1.469-7.667,P=0.004)were independent risk factors of SCM.Patients with SOFA score≥8 points during ICU admission had a 17.924-fold increased risk of SCM(aOR=17.924,95%CI:7.998-40.166,P=0.000).The ROC curve indicated that the model had good discriminative ability(AUC:0.902,95%CI:0.863-0.941).H-L test indicated that the model had certain calibration ability(x2=7.560,P=0.478),and the prediction accuracy of the model was 87.0%.Compared with NSCM,the rate of mechanical ventilation in the intensive care unit and the incidence of tracheotomy increased significantly,and the time of mechanical ventilation was also greatly extended(P<0.05).The use ratio of continuous renal replacement therapy and the number of deaths increased significantly,and the average length and cost of hospitalization was much higher than that of hospitalization(P<0.05).Conclusion:Choosing endoscopic surgery and SOFA score≥8 at ICU admission are independent risk factors of SCM within 48 hours after ICU admission in sepsis patients receiving surgery.For sepsis patients who need surgery,the choice of open surgery may reduce the occurrence of septic cardiomyopathy.Patients whose ICU admission SOFA score≥8 points,need to be alert to the occurrence of SCM,and the corresponding detection and treatment should be conducted in time.