Value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury

Zhiyu LI; Shaohua CUI; Lixia GENG

ABSTRACT

Objective:

To investigate the value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury.

Methods:

The clinical data of 103 patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from October 2018 to January 2021 were enrolled. According to the cardiac troponin I (cTnI) at admission of ICU, they were divided into septic myocardial injury group (cTnI ≥ 0.15 μg/L) and non-septic myocardial injury group (cTnI < 0.15 μg/L). The serum levels of heart-type fatty acid-binding protein (H-FABP), procalcitonin (PCT), C-reactive protein (CRP), MB isoenzyme of creatine kinase (CK-MB), cTnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 6 hours after ICU admission and the worst value of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score within 24 hours after ICU admission in 103 patients was recorded as well as the 28-day prognosis of patient with septic myocardial injury. Spearman correlation analysis was used to analyze the correlation of each index; receiver operating characteristic curve (ROC curve) was drawn, and the area under ROC curve (AUC) was calculated to analyze the early diagnosis and prognostic value of each index and APACHEⅡ score alone or combined detection in patients with septic myocardial injury.

Results:

① Among 103 patients with sepsis, 58 patients were complicated with myocardial injury and 45 patients were not complicated with myocardial injury. The serum levels of PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHEⅡ score in patients with septic myocardial injury were significantly higher than those in patients without septic myocardial injury [PCT (μg/L) 3.46±1.35 vs. 1.89±0.43, CRP (mg/L) 81.1±26.8 vs. 65.3±19.1, NT-proBNP (U/L) 8 261.4±2 346.9 vs. 6 120.2±1 809.6, CK-MB (U/L) 15.89±6.25 vs. 12.14±4.24, cTnI (μg/L) 1.50 (0.91, 2.21) vs. 0.18 (0.16, 0.19), H-FABP (μg/L) 26.45±8.24 vs. 12.82±5.73, APACHEⅡ score 24.0 (18.0, 29.0) vs. 16.0 (14.0, 18.0), all P < 0.01]. Spearman correlation analysis showed that PCT, CRP and APACHEⅡ scores were positively correlated with NT-proBNP, CK-MB, cTnI and H-FABP. ROC curve analysis showed that H-FABP in the diagnosis of septic myocardial injury (AUC = 0.916) was superior to NT-proBNP (AUC = 0.756) and CK-MB (AUC = 0.675); the AUC of NT-proBNP and CK-MB combined with H-FABP was 0.921, the sensitivity was 82.1%, and the specificity was 88.2%.② Twenty-three patients survived in 28 days, and 35 died. The levels of serum PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHEⅡ score in death group were significantly higher than those in survival group [PCT (μg/L) 3.86±1.27 vs. 2.84±1.24, CRP (mg/L) 92.3 (65.0, 101.7) vs. 74.3 (65.7, 79.8), NT-proBNP (ng/L) 9 106.4±2 013.9 vs. 6 975.5±2 266.7, CK-MB (U/L) 17.90±6.49 vs. 12.82±4.46, cTnI (μg/L) 2.11±0.86 vs. 1.12±0.44, H-FABP (μg/L) 30.08±7.90 vs. 20.93±5.14, APACHEⅡ score 25.0 (20.0, 30.0) vs. 19.0 (17.0, 24.0), all P < 0.01]. ROC curve analysis showed that H-FABP in evaluating 28-day death of patients with septic myocardial injury (AUC = 0.839) was superior to PCT (AUC = 0.707), CRP (AUC = 0.716), NT-proBNP (AUC = 0.761), CK-MB (AUC = 0.733), cTnI (AUC = 0.824) and APACHEⅡ score (AUC = 0.724); the AUC of NT-proBNP and cTnI combined with H-FABP was 0.888, the sensitivity was 91.4%, and the specificity was 82.6%.

Conclusions:

H-FABP plays an important role in the early diagnosis and prognosis of septic myocardial injury. Early combined detection of NT-proBNP, CK-MB and H-FABP can significantly improve the diagnostic ability of septic myocardial injury, and NT-proBNP and cTnI combined with H-FABP can significantly improve the ability to predict the adverse prognosis of sepsis myocardial injury.