脓毒症心肌病的危险因素分析及预测模型建立

Analysis of Risk Factors for Sepsis-Induced Cardiomyopathy and Establishment of a Prediction Model

摘要: 目的：分析脓毒症合并心肌损伤患者的危险因素，并构建风险预测模型。方法：本研究回顾性纳入了2023年11月至2024年8月在德宏州人民医院重症医学科诊断为脓毒症的患者。根据是否并发心肌损伤，将患者分为两组：脓毒症心肌病组(SCM组)和非脓毒症心肌病组(NSCM组)。结果：本研究共纳入脓毒症患者188例，其中SCM组83例，NSCM组105例，两组患者在年龄、性别、感染部位、机械通气情况、血管活性药物使用以及28天生存结局方面的差异均无统计学意义(P > 0.05)。单因素分析显示，与NSCM组相比，SCM组APACHEII评分、平均血小板体积(MPV)、中性粒细胞/淋巴细胞比值(NLR)、尿素氮/白蛋白(BUN/ALB)、血肌酐(Cr)、尿素氮(BUN)、天冬氨酸氨基转移酶(AST)水平均显著升高，差异有统计学意义(P < 0.05)，而血小板计数(PLT)、血小板/中性粒细胞比值(PNR)显著低于NSCM组，差异有统计学意义(P < 0.05)。将上述单因素分析中具有统计学差异的指标纳入多因素Logistic回归分析，结果显示：APACHE II评分、MPV、NLR是脓毒症心肌病发生的独立影响因素。结论：脓毒症心肌病的发生与APACHE II评分、MPV、NLR等多种因素相关。综合运用这些临床常用血液检测指标，有助于早期识别脓毒症心肌病的发生。

Abstract: Objective: To analyze the risk factors of patients with sepsis complicated with myocardial injury and to construct a risk prediction model. Methods: In this study, patients diagnosed with sepsis in the Intensive Care Unit of Dehong Prefecture People’s Hospital between November 2023 and August 2024 were retrospectively enrolled. Based on the presence or absence of concomitant myocardial injury, they were categorized into two groups: the sepsis-induced cardiomyopathy (SCM) group and the non-sepsis-induced cardiomyopathy (non-SCM) group. Result: A total of 188 patients with sepsis were enrolled in this study, including 83 patients in the sepsis-induced cardiomyopathy (SCM) group and 105 patients in the non-SCM (NSCM) group. No statistically significant differences were observed between the two groups in terms of age, sex, site of infection, requirement for mechanical ventilation, use of vasoactive agents, or 28-day survival outcome (all P  >  0.05). Univariate analysis revealed that compared with the NSCM group, the SCM group had significantly higher APACHE II scores, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), blood urea nitrogen-to-albumin ratio (BUN/ALB), serum creatinine (Cr), blood urea nitrogen (BUN), and aspartate aminotransferase (AST) levels (all P  <  0.05). In contrast, platelet count (PLT) and platelet-to-neutrophil ratio (PNR) were significantly lower in the SCM group (all P  <  0.05). Variables showing statistically significant differences in the univariate analysis were included in a multivariate logistic regression model. The results indicated that APACHE II score, MPV, and NLR were independent influencing factors for the development of sepsis-induced cardiomyopathy. Conclusion: Sepsis-induced cardiomyopathy correlates with various factors such as the APACHE II score, MPV, and NLR. The integrated application of these routinely available hematological indices facilitates the early identification of this condition.