Prognostic Value Of CTnI,CK,CK-MB And BNP In Myocardial Injury Patients With Sepsis

Objective: To evaluate the value of combined monitoring of cTnI,CK,CK-MB and BNP in the severity and prognosis of septic myocardial injury.Methods: The patients with septic myocardial injury admitted to the Emergency Intensive Care Unit(EICU)of the People’s Hospital of Xinjiang Uygur Autonomous Region from October 2020 to January2023 were selected as the study subjects by retrospective study.The diagnostic criteria were based on the diagnostic criteria for sepsis defined in the Guidelines for the Treatment of Sepsis and Septic Shock(2021).A total of 177 patients were diagnosed as septic myocardial injury with elevated troponin I.According to the 28-day prognosis of the patients,the patients were divided into survival group(87 cases)and death group(90cases).Collect the relevant indicators of the patients when they are admitted to the intensive care unit,including basic data,basic medical history,vital signs,infection sites,laboratory examination indicators(cTnI,CK,CK-MB,BNP,blood routine,D-dimer,fibrinogen,international normalized ratio(INR),and take the 24-hour worst value),calculate the sequential organ failure(SOFA)score,acute physiology and chronic health status(APACHE II)score,The follow-up of 28 days was recorded.The above collected basic data and laboratory examination indexes were analyzed by univariate analysis,and then the statistical difference indexes were further processed by multivariate logistic regression equation to screen out the risk factors affecting the prognosis of septic myocardial injury,and the ROC curve was drawn to evaluate the predictive value of cTnI,CK,CK-MB,BNP alone and in combination for the prognosis of septic myocardial injury.Results:(1)The data of 177 patients with septic myocardial injury were collected,87 survived and 90 died.The scores of SOFA(Z=3.293,P<0.001)and APACHEII(Z=3.916,P<0.001)in the death group were significantly higher than those in the survival group,and the difference was statistically significant(P<0.05);(2)The death group had higher cTnI(Z=6.611,P<0.001),CK(Z=5.229,P<0.001),CK-MB(Z=3.671,P<0.001),BNP(Z=5.993,P<0.001)and lower ejection fraction(Z=2.516,P<0.001).Lymphocytes were lower(Z=4.584,P<0.001),and there was no significant difference in leukocytes,neutrophils,CRP and IL-6(all P>0.05);(3)Taking whether the patient died as the dependent variable,taking cTnI,CK,CK-MB,BNP,SOFA score,APACHE Ⅱ score as the independent variable,cTnI(OR=1.548,CI=1.069-2.241,P=0.021),CK(OR=1.002,CI=1.001-1.003,P=0.017),CK-MB(OR=1.027,CI=1.006-1.050,P=0.013),BNP(OR=1.001,CI=1.000-1.002,P=0.001)SOFA score(OR=1.201,95%,CI=1.054-1.368,P=0.006)APACHE II score(OR=1.092,95%,CI=1.023-1.165,P=0.008)has statistical significance in the model(P<0.05),among which cTnI,CK,CK-MB,BNP,SOFA score,APACHE II score are the risk factors that affect the death of patients,that is,the risk of death of patients is 9.2% for every increase in APACHEII score;For every increase in SOFA score,the risk of death was 1.21;The risk of death of patients is 54.8% for each unit of cTnI increase;The risk of death of patients is 0.2% for each unit of increase in CK;For each unit of CK-MB increase,the risk of death of patients is 2.7%;The risk of death of patients is 0.1% for each unit of BNP increase;(4)The ROC curves of cTnI,CK,CK-MB and BNP in the two groups were drawn.The results showed that the AUC of cTnI predicting the 28-day mortality of septic myocardial injury was 0.781.When the cutoff value was0.08,its diagnostic efficiency was the highest,with sensitivity of 60% and specificity of94.5%;The AUC of CK in predicting the 28-day mortality of septic myocardial injury was0.731.When the cutoff value was 235,its diagnostic efficiency was the highest,with sensitivity of 92.22% and specificity of 58.02%;The AUC of CK-MB in predicting the28-day mortality of septic myocardial injury was 0.652.When the cutoff value was 32,its diagnostic efficacy was the highest,with sensitivity of 60.00% and specificity of 72.41%;The AUC of BNP in predicting the 28-day mortality of septic myocardial injury was 0.754.When the cutoff value was 580,its diagnostic efficacy was the highest,with sensitivity of60.23% and specificity of 85.06%;The AUC of cTnI+CK+CK-MB+BNP in predicting the28-day mortality of septic myocardial injury was 0.844,the sensitivity was 88.64%,and the specificity was 69.14%.Conclusion: 1.cTnI,CK,CK-MB and BNP are of clinical value in evaluating the prognosis of patients with septic myocardial injury.2.APACHEII score,SOFA score,ejection fraction,lymphocyte,cTnI,CK,CK-MB,BNP are the risk factors that affect the death of patients.The accuracy of combined detection of cTnI,CK,CK-MB,BNP in predicting the mortality of septic myocardial injury is better than that of single myocardial index.