脓毒症患者高敏心肌肌钙蛋白T预后价值及升高的危险因素

目的 评估高敏心肌肌钙蛋白T(hs-cTnT)对脓毒症患者28 d内预后的预测价值,并探讨影响脓毒症患者发生hs-cTnT升高的危险因素。方法 选取2017年12月至2021年9月重庆医科大学附属第二医院重症监护病房收治的脓毒症患者的临床资料,以在入住重症监护病房期间是否发生hs-cTnT>0.1 ng/ml分为hs-cTnT升高组和hs-cTnT非升高组,比较两组患者预后及确定hs-cTnT升高的危险因素。结果 共纳入225例脓毒症患者,hs-cTnT升高组49例(21.8%),hs-cTnT非升高组176例(78.2%)。最大hs-cTnT对脓毒症患者28 d内预后有预测价值,受试者工作特征曲线下面积及95%置信区间(95%CI)为0.767(0.699~0.835),灵敏度为62.5%,特异度为79.9%(P<0.001)。hs-cTnT升高组28 d内死亡率较hs-cTnT非升高组明显增高(53.1%比17.0%,χ²=26.595,P<0.001)。年龄≥75.5岁(OR=5.990,95%CI=2.143~16.742,P=0.001)、乳酸≥4.05 mmol/L(OR=4.982,95%CI=1.433~17.315,P=0.012)、氧合指数≤169.15 mmHg)(1 mmHg=0.133 kPa)(OR=5.052,95%CI=1.888~13.514,P=0.001)、B型利尿钠肽前体≥6 687.0 pg/ml(OR=5.991,95%CI=2.226~16.128,P<0.001)、纤维蛋白原≤2.87 g/L(OR=3.325,95%CI=1.175~9.404,P=0.024)与国际血栓与止血协会显性弥散性血管内凝血评分≥5.5分(OR=7.631,95%CI=1.157~50.338,P=0.035)为脓毒症患者hs-cTnT升高的独立危险因素。结论 hs-cTnT对脓毒症患者28 d内死亡率有较好的预测价值。凝血异常、微血栓形成及心肌氧供需不匹配可能是脓毒症心肌损伤的潜在危险因素。

High-sensitivity Cardiac Troponin T in Sepsis:Prognostic Value and Risk Factors of Its Elevation

Objective To explore the prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) in predicting mortality within 28 days among sepsis patients,and to investigate the risk factors of hs-cTnT elevation. Methods The clinical and laboratory data of patients with sepsis or septic shock who were hospitalized at the Second Affiliated Hospital of Chongqing Medical University from December 2017 to September 2021 were collected and retrospectively analyzed.The patients were assigned into a hs-cTnT elevated group (hs-cTnT>0.1 ng/ml) and a hs-cTnT non-elevated group (hs-cTnT≤0.1 ng/ml).The prognosis was compared between the two groups and the risk factors of hs-cTnT elevation were determined. Results A total of 225 patients were included in this study,including 49 in hs-cTnT elevated group (21.8%) and 176 in hs-cTnT non-elevated group (78.2%).The receiver operating characteristic curve showed that maximum hs-cTnT had predictive value for death within 28 days (P<0.001).The maximum hs-cTnT showed the area under the receiver operating characteristic curve of 0.767 (95%CI=0.699-0.835),the sensitivity of 62.5%,and the specificity of 79.9%.The mortality within 28 days of hs-cTnT elevated group was higher than that of hs-cTnT non-elevated group (53.1% vs. 17.0%, χ²=26.595, P<0.001).Multivariate Logistic regression analysis revealed that the independent predictors of hs-cTnT elevation were age ≥75.5 years (OR=5.990, 95%CI=2.143-16.742, P=0.001),lactate ≥4.05 mmol/L (OR=4.982,95%CI=1.433-17.315,P=0.012),oxygenation index ≤169.15 mmHg (OR=5.052, 95%CI=1.888-13.514, P=0.001),B-type brain natriuretic peptide precursor ≥6 687.0 pg/ml (OR=5.991, 95%CI=2.226-16.128, P<0.001),fibrinogen ≤2.87 g/L (OR=3.325,95%CI=1.175-9.404, P=0.024),and International Society on Thrombosis and Haemostasis overt disseminated intravascular coagulation score ≥5.5 (OR=7.631, 95%CI=1.157-50.338, P=0.035). Conclusions hs-cTnT showed good performance in predicting mortality within 28 days among the patients with sepsis.Coagulation disorder,microthrombus formation,and myocardial oxygen supply-demand mismatch may be the risk factors of myocardial injury in sepsis.