The analysis of short-term prognosis of elderly patients with sepsis-induced myocardial dysfunction and its risk factors / 中华老年医学杂志

ABSTRACT

Objective:To investigate the 30-day mortality risk in elderly patients with sepsis-induced myocardial dysfunction(SIMD), and to analyze its related risk factors.Methods:This was a multicenter retrospective case-control study.A total of 254 elderly patients with sepsis or septic shock admitted to the Second Hospital of Shanxi Medical University(117 cases), the First Hospital of Shanxi Medical University(89 cases)and Shanxi Provincial People's University(48 cases)from January 2015 to December 2019 were enrolled.According to whether or not combined with SIMD, patients were divided into the SIMD group(n=68)and the control group(n=186). All patients were followed for 30 day to evaluate the rate of mortality and the related factors.Results:Among 254 elderly patients, the incidence of SIMD was 26.8%.There were significant differences between the SIMD group and the control group in age, heart rate, E/A value, left ventricular ejection fraction(LVEF), procalcitonin, lactate, C-reactive protein, troponin, N-terminal pro-B-type natriuretic peptide(NT-proBNP)and sequential organ failure assessment(SOFA)score(all P<0.05). The significant differences were found between the SIMD group and the control group in the all-cause mortality risk, the duration of invasive mechanical ventilation, ICU hospitalization time and total hospitalization days(35.3% or 24 cases vs.22.6% or 42 cases, 7.0 d vs.4.8 d, 9.5 d vs.7.5 d and 18.8 d vs.15.1 d, P<0.05). Age ≥65 years( RR=1.867), diabetes( RR=2.661), procalcitonin ≥13.2 μg/L( RR=3.307), and lactate ≥3.65 mmol/L( RR=2.964)were risk factors for SIMD, and serum troponin ≥0.08 μg/L( HR=2.019), NT-proBNP ≥537.4 ng/L( HR=4.411), lactate ≥3.65 mmol/L( HR=3.934)and LVEF <50.0%( HR=3.761)were risk factors for the mortality(all P<0.05). Conclusions:Elderly patients with the sepsis-induced SIMD have severe infections, mainly involving the left ventricle, and have an increased risk of mortality and a longer duration of hospital stays.