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Objective:To evaluate the value of endogenous digitalis-like factor (EDLF) dynamic changes in predicting myocardial injury and prognosis in patients with sepsis.Methods:A total of 160 sepsis patients admitted to the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to January 2019 were selected and divided into the myocardial injury(MI) group ( n=75) and the non-myocardial injury (NMI) group ( n=85) according to whether there was myocardial injury. The plasma EDLF concentration was tested on the 1 st, 3 rd and 7 th day after admission. The predictive factors of MI and 90-days outcome were evaluated by logistics regression analysis. Cox proportional hazards regression model was used to estimate the prognostic value of EDLF concentration on the 90 days after admission for sepsis. Results:Septic patients with MI had increased levels of myocardial enzymes, decreased left ventricular fractional shortening index (FS) and interventricular septum (IVS) amplitude and abnormal wall motion, when compared to NMI patients (all P<0.05). EDLF concentration on the 7 th day in the MI group was significantly lower than in the NMI group ( P=0.019). Logistic regression showed that EDLF 7 th was an independent protective factor for MI and 90-day mortality in sepsis respectively ( OR=0.964, 95% CI: 0.934-0.994, P=0.021; OR=0.931, 95% CI: 0.871-0.995, P=0.036). Cox proportional hazards regression analysis suggested that EDLF 7 th concentration <26.7 pmol/L was an independent predictor of 90-day mortality in patients with sepsis ( HR=4.601, 95% CI: 1.030-20.563, P=0.046). Conclusions:EDLF 7 th may serve as a protective factor for sepsis-induced MI and adverse outcome. The exogenous supplement of cardiotonic drugs at one week after MI may be a potential treatment to improve the survival rate of septic patients.
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Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.
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Objective To analyze the clinical characteristics and risk factors of myocardial injury (MI) in patients with sepsis.Methods Totally 160 patients with sepsis in April 2016 to December 2017,divided into the MI group and non-MI group.The clinical data laboratory findings and ultrasonic cardiographic findings were recorded and compared between the two groups.Binary logistic regression analysis was performed to find the independent risk factors of/MI in patients with sepsis.Results Total of 160 patients with sepsis 75 (46.9％) patients developed MI.The MI group had older age and more patients with history of hypertension than the non-MI group (P＜0.05).In patients with sepsis,diastolic dysfunction accounted for 84.1％,systolic dysfunction accounted for 4.3％,and ventricular wall dyskinesia accounted for 17.3％.Compared with the non-MI group,the MI group had more abnormal wall motion (9.6％ vs 25.8％,P=0.012),lower interventricular septal amplitude (0.87±0.16 vs 0.80±0.21,P=0.03) and left ventricular posterior wall amplitude (1.03±0.21 vs 0.96±0.18,P=0.034),and decreased fractional shortening (P=0.033).Binary logistic regression analysis showed that age (RR=1.033,P=0.018) and decreased fractional shortening (RR=0.000,P=0.024) were independent risk factors of MI in patients with sepsis.Conclusions Age and decreased fractional shortening were independent risk factors of myocardial injury in patients with sepsis.
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Objective To explore the relationship between those myocardial markers serum cardiac troponin T (cTNT),serum cardiac troponin I (cTNI),N-terminal pro-brain natriuretic peptide (NT-proBNP),echocardiography and myocardial injury in the oldest-old septic patients,as well as to evaluate prognosis in the oldest-old septic patients.Methods 140 oldest-old septic patients hospitalized in Beijing Friendship Hospital from January 1 st,2015 to Jun 31st,2017 were collected and analyzed retrospectively.They were divided into survival group (90 cases) death group (50 cases)according to their survival time.Serum cTNT,cTNI and NT-proBNP level at 1,3 and 7d post-diagnosis were collected and echocardiography left ventricular diastolic diameter (EDD),left ventricular systolic diameter (ESD),right ventricular diameter (RV),left ventricular ejection fraction (EF) was performed.Results 140 oldest-old septic patients were enrolled in the analysis.There were 90 cases in survival group and 50 cases in death group.Mean values of cTNT,cTNI,NT-proBNP,EDD,ESD in survival group were obviously higher than those in death group (P ＜ 0.05),left ventricular ejection fraction (LVEF) in survival group was lower than that in death group (P ＜ 0.01).But there were no difference in E/A and RV between survival group and death group (P ＞ 0.05).There were positive correlation between cTNT,cTNI,NT-proBNP and EDD,ESD (P ＜ 0.05),negative correlation between cTNT,cTNI,NT-proBNP and LVEF (P ＜ 0.05),and no correlation between cTNT,cTNI,NT-proBNP and E/A,RV (P ＞0.05).There were obviously correlation between cTNT,cTNI,NT-proBNP,EDD,ESD and mortality rate (OR ＞ 1,P ＜ 0.05).It was shown the prognosis value of cTNT,cTNI,NT-proBNP,EDD,ESD to mortality rate in oldest-old septic patient.The prognosis value was cTNT ＞ NT-proBNP ＞ cTNI ＞ EDD ＞ ESD.Conclusions There were obviously correlation between cT NT,cTNI,NT-proBNP,EDD,ESD and myocardium restrain,heart dysfunction as well as mortality rate.cTNT was the best prognosis indicator in sensitivity,and NT-proBNP was the best prognosis indicator in specificity.The combination of cTNT and NT-proBNP can better forecast the prognosis of the oldest-old septic patient.
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Objective To investigate the ultrasound measured inferior vena cava (IVC) caliber used as an objective indicator to assess water retention of patients with acute heart failure (AHF).Methods A total of 72 consecutive patients with acute heart failure admitted in the emergency department between December 2013 and April 2014 were enrolled.Acute heart failure was defined by the presence of symptoms such as asthmatic embarrassment and nocturnal paroxysmal dyspnea with or without signs of tracheobronchchial rale and edema of lower limbs,and by objective evidence of cardiac dysfunction as well,either a left ventricular ejection fraction (LVEF) ≤ 45％ or the combination of both left atrium dilation (≥ 4 cm diameter in the parasternal long axis) and a plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) ＞ 450 pg/mL (patients under 50 years old) or ＞ 900 pg/mL (patients over 50 years old and under 75 years old) or ＞ 1800 pg/mL (patients over 75 years old) or ＞ 1200 pg/mL (patients with renal dysfunction,glomerular filtration rate ＜ 60 mL/min).Exclusion criteria were chronic hepatic disease and acute myocardial infarction.Another 22 patients were enrolled as control.Independent t tests were used to compare normally distributed continuous variables between two groups,while nonparametric tests were used to compare non-normally distributed continuous ones,and chi-squared tests were used for categorical variables.The relations between IVC inner diameter and other normally distributed variables were assessed by Pearson correlation coefficients.A 2-sided P value ＜ 0.05 was considered statistically significant.Results The congestion score and IVC inner diameter were significantly higher in patients with AHF (P ＜ 0.05 ; P ＜ 0.01).The IVC inner diameter was correlated with NT-proBNP concentration (r =0.339,P =0.01 3) and congestion score (r =0.431,P =0.002).There was no relation between IVC inner diameter and LVEF (r =-0.241,P =0.102).IVC inner diameter had significantly positive correlations with pulmonary artery pressure and tricuspid regurgitation (r =0.414,P =0.004 ; r =0.359,P =0.015).Creatinine,blood urea nitrogen,and bilirubin were independently associated with increasing IVC inner diameter (r =0.313,P =0.032 ; r =0.379,P =0.009 ; r =0.385,P =0.007),while IVC inner diameter had negative relation with glomerular filtration rate (r =-0.337,P =0.021).Conclusions The IVC inner diameter can be used as a measurable and objective indicator to estimate the magnitude of access water retention in patients with AHF.