Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome
Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome
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DOI：
10.1161/circoutcomes.117.004040
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发表时间：
2018-02-01
影响因子：
6.9
通讯作者：
Cremer, Olaf L.
中科院分区：
文献类型：
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作者：
Frencken, Jos F.;Donker, Dirk W.;Cremer, Olaf L.
背景：脓毒症常伴有心肌肌钙蛋白的释放，但这种心肌损伤的临床意义尚不清楚。我们研究了败血症期间肌钙蛋白释放与1年预后之间的关系。方法和结果：我们在2011年至2013年期间在荷兰的2个重症监护病房连续招募了脓毒症患者。排除临床有明显肌钙蛋白释放原因的受试者。在重症监护病房的前4天，每天测量血浆中高敏心肌肌钙蛋白I （hs-cTnI）浓度，并使用多变量Cox回归分析来模拟其与1年死亡率的关系，同时调整混杂因素。此外，我们还研究了出院后第一年发生的心血管疾病。在1258例败血症患者中，1124例（89%）符合纳入研究的条件。673名（60%）受试者在第1天Hs-cTnI浓度升高，755名（67%）受试者在前4天出现Hs-cTnI水平升高。Cox回归分析显示，高hs-cTnI浓度与前14天死亡率增加相关（调整风险比为1.72,95%可信区间为1.14-2.59，风险比为1.70,95%可信区间为1.10-2.62，hs-cTnI浓度分别为100-500 ng/L和100-500 ng/L），但此后则无关。此外，在200名医院幸存者中，hs-cTnI水平升高与心血管疾病的发生有关（调整后的亚分布风险比为1.25；95%可信区间为1.04-1.50）。结论：心肌损伤发生在大多数脓毒症患者中，并且与早期而非晚期死亡率以及出院后心血管发病率独立相关。
BACKGROUND: Sepsis is frequently complicated by the release of cardiac troponin, but the clinical significance of this myocardial injury remains unclear. We studied the associations between troponin release during sepsis and 1-year outcomes.METHODS AND RESULTS: We enrolled consecutive patients with sepsis in 2 Dutch intensive care units between 2011 and 2013. Subjects with a clinically apparent cause of troponin release were excluded. High-sensitivity cardiac troponin I (hs-cTnI) concentration in plasma was measured daily during the first 4 intensive care unit days, and multivariable Cox regression analysis was used to model its association with 1-year mortality while adjusting for confounding. In addition, we studied cardiovascular morbidity occurring during the first year after hospital discharge. Among 1258 patients presenting with sepsis, 1124 (89%) were eligible for study inclusion. Hs-cTnI concentrations were elevated in 673 (60%) subjects on day 1, and 755 (67%) ever had elevated levels in the first 4 days. Cox regression analysis revealed that high hs-cTnI concentrations were associated with increased death rates during the first 14 days (adjusted hazard ratio, 1.72; 95% confidence interval, 1.14-2.59 and hazard ratio, 1.70; 95% confidence interval, 1.10-2.62 for hs-cTnI concentrations of 100-500 and >500 ng/L, respectively) but not thereafter. Furthermore, elevated hs-cTnI levels were associated with the development of cardiovascular disease among 200 hospital survivors who were analyzed for this end point (adjusted subdistribution hazard ratio, 1.25; 95% confidence interval, 1.04-1.50).CONCLUSIONS: Myocardial injury occurs in the majority of patients with sepsis and is independently associated with early-but not late-mortality, as well as postdischarge cardiovascular morbidity.