ABSTRACT
Objective To investigate the expression of cardiac troponin-Ⅰ (cTnⅠ) levels in patients diagnosed with sepsis-associated myocardial dysfunction and explore the relationship between cTn Ⅰ and cardiac systolic and diastolic function.Additionally,we evaluated the prognostic value of cTn Ⅰ as a valuable biomarker.Methods We admitted 65 patients with sepsis.Using echocardiography,the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e') and the left ventricular ejection fraction (LVEF) were measured as an evaluation index of left ventricular diastolic and systolic function,respectively.Patients were divided into a cardiac dysfunction and a normal cardiac function group.The cTn Ⅰ level was measured and compared between the two groups,and we determined the correlation between cTn Ⅰ levels and cardiac diastolic and systolic function.Based on assessment of 28-day mortality,cases were divided into a survivor and a death group.A receiver operating characteristic curve was constructed to predict the prognostic value of cTn Ⅰ.Results The cTn Ⅰ level in the cardiac dysfunction group was significantly higher than that observed in the normal cardiac function group (P ＜ 0.05) and showed a positive correlation with E/e'(r =0.421,P =0.008).However,there was no correlation noted between the cTn Ⅰ level and LVEF (P ＞ 0.05).Compared to the survivor group,the level of cTn]Ⅰ was significantly higher in the death group (P ＜ 0.05).The prognostic value of cTn Ⅰ area under the curve was 0.892,with a cut-off value of 0.82 ng/mL (sensitivity =88.0％ and specificity =82.5％).Conclusion The cTn Ⅰ level is noted to be significantly elevated in patients with sepsis-associated cardiac dysfunction and shows a positive correlation with left ventricular diastolic function.A cTn Ⅰ level ≥ 0.82 ng/mL can be used as a valuable predictor of mortality in patients with sepsis.
ABSTRACT
Objective To investigate the effect of individualized and comprehensive therapy in treatment of severe acute pancrea-titis in early stage for preventing MODS .Methods 85 patients with severe acute pancreatitis treated in this Chengde medical college affiliated hospital from January 2008 to January 2012 were divided into two groups .The control group included 42 patients ,all used conventional basic treatment ;the test group included 43 patients ,and all used individualized and comprehensive therapy in early stage .The APACHEⅡ ,MODS and Ranson scores ,and serum inflammatory cytokines indexes of patients in each group before and after admission were all recorded .Results The APACHEⅡ and MODS scores after admission of test group were significantly low-er than the control group(P< 0 .05) .The TNF α,CRP and IL 10 after admission of two groups had significant difference (P<0 .05) .The MODS incidence of control group was 64 .3% (27/42) ,pancreatic encephalopathy incidence was21 .4% (9/43) ,the inci-dence of pancreatic infection was 33 .3% (14/42) ,hospital mortality incidence was 19 .1% (8/42) and length of hospital stay was (30 .4 ± 5 .7) d .The MODS incidence of test group was 27 .9% (12/43) ,pancreatic encephalopathy incidence was11 .6% (5/43) , pancreatic infection rate was 14 .0% (6/43) ,hospital mortality incidence was 4 .7% (2/43) and length of hospital stay was (23 .5 ± 4 .3) d .The incidence of MODS ,hospital mortality and pancreatic infection rates of test group were significantly lower than that of the control group (P<0 .05) .The average length of stay of test group were significantly lower than the control group (P<0 .05) . Conclusion To use individualized and comprehensive therapy in treatment of severe acute pancreatitis in early stage can reduce MODS ,protect organ function ,and reduce mortality .