ABSTRACT
Objective:
To observe the value of
heart-type
fatty acid-binding protein (
H-FABP) and echocardiographic indexes in the
diagnosis of cardiac insufficiency in
sepsis.
Methods:
A prospective
observational study was conducted. Eighty
patients with
sepsis admitted to the department of
critical care medicine of the First Affiliated
Hospital of Medical College of Shihezi
University from October 2016 to January 2018 were enrolled. General clinical data such as
gender, age,
acute physiology and chronic health evaluationⅡ(
APACHEⅡ), sequential organ failure assessment (SOFA) score,
hospitalization time and 28-day
mortality were recorded. Echocardiographic indexes at 1, 3, 7, 10 days after
diagnosis, and
white blood cell (WBC), neutrophilic
granulocyte percentage (N%), N-terminal pro-
brain natriuretic peptide (NT-proBNP),
serum H-FABP level were recorded.
Sepsis patients were divided into normal cardiac function group ( n = 30) and cardiac insufficiency group ( n = 50) according to cardiac function, the differences of echocardiographic indexes and cardiac markers between the two groups at different
time points were compared.
Logistic regression was used to screen out cardiac ultrasound indexes and cardiac markers that
affect the occurrence of cardiac dysfunction in
sepsis patients, and then
receiver operating characteristic (ROC) curve
analysis was performed.
Results:
Comparing the general data of the two groups, only the SOFA score of the cardiac insufficiency group was significantly higher than that of the normal cardiac function group (6.12±4.09 vs. 4.57±2.45, P < 0.05). N% and
H-FABP in cardiac insufficiency group were higher than those in normal cardiac function group at the same
time (N% F = 6.973, P = 0.010;
H-FABP F = 17.303, P = 0.000). Without considering the
time factor, there were significant differences in left
ventricular end-diastolic volume (LVEDV), left
ventricular end-systolic volume (LVESV), left
ventricular ejection fraction (LVEF),
stroke volume (SV),
cardiac output (CO), left ventricular fractional shortening (LVFS), E-point of septal
separation (EPSS), isovolumic
relaxation time (IVRT), E peak
deceleration time (EDT), A peak duration (Ad), left ventricular systolic
pulmonary vein velocity (S),
blood flow velocity of
pulmonary vein in early left ventricular diastolic period (D), tricuspid orifice early diastolic
blood flow velocity (E'), tricuspid orifice late diastolic
blood flow velocity (A'), systolic velocities of the right ventricular free wall tricuspid annulus (Sm), and
pulmonary valve annulus
blood flow velocity (PVBV) between the two groups.
ROC curve analysis of cardiac ultrasound
indicators and cardiac markers screened by
Logistic regression showed that the area under
ROC curve (
AUC) and the positive and
negative predictive values were LVEDV was 0.636, 77.30%, 56.03%; SV was 0.779, 88.82%, 71.19%; LVEF was 0.753, 92.12%, 55.21%; CO was 0.754, 88.82%, 77.19%; LVFS was 0.728, 81.25%, 66.99%; EPSS was 0.663, 96.99%, 51.56%; IVRT was 0.775, 86.97%, 73.55%; A' was 0.908, 96.58%, 89.60%; Sm was 0.738, 93.37%, 56.77%;
H-FABP was 0.673, 80.26%, 57.25%, respectively.
H-FABP was tested in parallel with LVEDV, SV, LVEF, CO, LVFS, EPSS, IVRT, A', Sm, and the
positive predictive values were higher than the single
diagnostic test (85.45%, 93.91%, 96.72%, 94.74%, 89.43%, 98.00%, 92.00%, 99.42%, 93.60%, respectively), the
negative predictive values were lower than the single
diagnostic test (50.89%, 57.93%, 49.15%, 58.18%, 57.05%, 45.74%, 57.92%, 64.13%, 47.78%, respectively).
Conclusion:
Cardiac ultrasound
indicators LVEDV, SV, LVEF, CO, LVFS, EPSS, IVRT, A', and Sm combined with
H-FABP are of certain value in the
diagnosis of
sepsis-associated
heart dysfunction.
