Clinical investigation on the risk factors for prognosis in patients with septic shock / 中华危重病急救医学

ABSTRACT

Objective To study the risk factors of prognosis in patients with septic shock, and to provide a reliable evidence to evaluate severity. Methods A retrospective analysis was conducted. The data of 185 patients with septic shock admitted to the intensive care unit (ICU) of Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2016 to December 2018 were enrolled. Routine blood test, blood biochemistry, blood gas analysis, myoglobin (Myo), cardiac troponin I (cTnI), blood lactic acid (Lac), procalcitonin (PCT) and ratio of C-reactive protein and albumin (CRP/ALB) of patients on the day of septic shock diagnosis were collected. Glasgow coma scale (GCS), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and multiple organ dysfunction score (MODS) as well as the time from hospitalization to septic shock and duration of mechanical ventilation were recorded. The patients were divided into death group and survival group according to whether they survived or not on 28 days. According to Myo level, the patients were divided into two groups Myo elevation group (Myo > 98 μg/L) and Myo normal group (Myo≤98 μg/L). Patients with Myo elevation were divided into survival subgroup and death subgroup according to the prognosis of 28 days. The clinical data were compared among the groups, and the influencing factors of prognosis in septic shock patients were screened by multivariate Logistic regression analysis. Results 185 patients were all enrolled in the final analysis, there were 106 deaths and 79 survivors on 28 days, 154 patients with elevated Myo and 31 patients with normal Myo. ① Compared with the patients with septic shock in the survival group, the death group had older patients, increased qSOFA, APACHEⅡ, MODS scores and blood Myo, Lac, PCT levels, faster heart rate, decreased GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. However, there was no significant difference in cTnI or CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.037, 95% confidence interval (95%CI) was 1.010-1.065, P = 0.007], heart rate (OR = 1.020, 95%CI was 1.003-1.037, P = 0.023), qSOFA score (OR = 2.839, 95%CI was 1.321-6.102, P = 0.008), Myo (OR = 1.492, 95%CI was 1.088-2.045, P = 0.013), time from hospitalization to septic shock (OR = 0.938, 95%CI was 0.898-0.980, P = 0.004) and duration of mechanical ventilation (OR = 0.936, 95%CI was 0.899-0.975, P = 0.001) were independent risk factors for prognosis in patients with septic shock. ② Compared with Myo normal group, the Myo elevation group had higher 28-day mortality [61.0% (94/154) vs. 38.7% (12/31), χ2 = 5.259, P = 0.022]. Compared with the survival patients with elevated Myo, the death patients were older, and had higher PCT and qSOFA score, faster heart rate, lower GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. But there was no significant difference in CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that qSOFA score (OR = 2.796, 95%CI was 1.270-6.153, P = 0.011), time from hospitalization to septic shock (OR = 0.925, 95%CI was 0.884-0.967, P = 0.001) and duration of mechanical ventilation (OR = 0.931, 95%CI was 0.884-0.980, P = 0.006) were independent risk factors for the prognosis in the septic shock patients with elevated blood Myo. Conclusions Age, heart rate, qSOFA score, Myo, time from hospitalization to septic shock, duration of mechanical ventilation were independent risk factors for the prognosis of patients with septic shock. The 28-day mortality in patients with elevated blood Myo was significantly higher than that in those with normal blood Myo. The qSOFA score, time from hospitalization to septic shock and duration of mechanical ventilation were independent risk factors for the prognosis of septic shock patients with elevated blood Myo.