Clinical characteristics and prognosis of children with sepsis complicated with myocardial injury / 中国医师进修杂志

ABSTRACT

Objective:To investigate the clinical features and prognostic factors in children with sepsis complicated with myocardial injury.Methods:The clinical data of children with sepsis complicated with myocardial injury from January 2017 to January 2019 in Department of Intensive Care Unit, Children′s Hospital of Kunming City, were retrospectively analyzed. The pediatric critical illness score (PCIS) at admission, gender, age, infection site, clinical outcome, mechanical ventilation and blood purification were recorded. The etiological results, creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), myoglobin, hypersensitive cardiac troponin T (hs-cTnT), procalcitonin (PCT), lactate, left ventricular ejection fraction (LVEF), cardiac output, left ventricular truncation rate (LVFS) were recorded. According to the clinical results, the children were divided into improvement group and deterioration group, and the clinical data of each group were compared. The receiver operating characteristic (ROC) curve and multivariate Logistic regression were used to screen the relevant clinical indicators that could predict the prognosis of children.Results:A total of 138 children with sepsis complicated with myocardial injury were enrolled. Thirty cases died in 28 d, and the mortality of 28 d was 21.7%. The respiratory tract was the main infection site, and the main pathogens were gram-negative bacteria and virus. The 35.4% (28/79) of children were complicated with multiple infections. There were 102 cases in improvement group; and there were 36 cases in deterioration group, among whom 5 cases died in hospital and 31 cases was discharged without treatment. The proportion of the girls in deterioration group was significantly higher than that in improvement group 63.9% (23/36) vs. 34.3% (35/102), and there was statistical difference ( P<0.01); there were no statistical differences in age, infection site, mechanical ventilation, blood purification and PCIS between 2 groups ( P>0.05). The hs-cTnT and lactate in deterioration group were significantly higher than those in improvement group (1.87 ± 0.67) ng/L vs. (1.62 ± 0.51) ng/L and (0.46 ± 0.31) ng/L vs. (0.34 ± 0.27) ng/L, and there were statistical differences ( P<0.05); there were no statistical differences in CK, CK-MB, myoglobin, PCT, LVEF, cardiac output and LVFS between 2 groups ( P>0.05). ROC curve analysis result showed that the hs-cTnT and lactate were risk factors for predicting clinical prognosis in children with sepsis complicated with myocardial injury, the area under the curve were 0.623 and 0.613, the optimal value were 159.59 and 2.65 ng/L, with a sensitivity of 36.1% and 55.6%, and a specificity of 98.2% and 70.6%. Multivariate Logistic regression analysis result showed that the hs-cTnT and gender were independent risk factors for prognosis ( OR = 2.237 and 0.286, 95% CI 1.093 to 4.578 and 0.127 to 0.644, P = 0.028 and 0.003). Conclusions:The 28 d mortality in children with sepsis complicated with myocardial injury is higher, and the respiratory tract is the most common infection site. The increased hs-cTnT and lactate levels indicate that the prognosis is poor in children with sepsis complicated with myocardial injury. The hs-cTnT and and gender are independent risk factors of prognosis.