The Epidemiological Investigation Of Sepsis,Sepsis-induced Myocardial Dysfunction (SIMD) In Intensive Care Unit Of Tertiary Hospitals In Hebei Province

Objective: Sepsis is very common in intensive care unit(ICU),which can lead to serious complications,such as severe sepsis,sepsis-induced myocardial dysfunction(SIMD).It is the main cause of morbidity and mortality in ICU,leading a great threat to human health and receiving recent attention.The purpose of this study is to describe the epidemiology and outcome of sepsis and SIMD in ICU of tertiary hospitals in Hebei Province,as well as the independent predictors of mortality.It provides important data for clinical and basic research of sepsis and SIMD,to further understand its epidemiological characteristics,which to fill the blank of sepsis and SIMD,in order to improve the level of diagnosis and treatment of sepsis,and SIMD.Methods: We performed a prospective,observational study from May2016 to September in ICU in 30 tertiary hospitals in Hebei Province.All admissions in ICU during the study period were screened and patients with sepsis were enrolled according to the 2012 SSC guideline.Each ICU has the ability to manage sepsis and its complications.For each selected patient,echocardiography Simpson’s method was used to gain left ventricular ejection fraction(LVEF)to identify whether the patient has SIMD.The basic clinical data included the patient’s name,gender,age,primary site of infection,mechanical ventilation time,the length of ICU stay,the 28 th day’s prognosis.The data also included the oxygenation index(P/F),Lac,WBC,PCT,CRP,Scr,TnI and other indicators.Then we calculated the APACHE II,SOFA and MODS score with the worst value during the first 24 hr.All the sepsis patients were divided into the survival group and the death group according to the prognosis.SIMD patients were also divided into survival and death group.Thedata was collected by a special person and analyzed by SPSS 22.0 statistical software to analyze the morbidity,mortality,infection characteristics,prognosis and death risk factors.Results:1 This study included 5704 patients,excluding refused to participate the experiment,ultrasonic image is not clear and dropped out of the study.The study finally enrolled 4897 patients.According to the 2012 SSC guideline,1536 sepsis patients were identified.The sepsis incidence rate was 31.48%,the 28 day mortality rate was 27.40%.The severe sepsis patients were 486,the incidence rate was 9.39%,the 28 day mortality rate was 50.41%.The SIMD patients were 234,the incidence rate was 4.79%,the 28 day mortality rate was42.31%.2 The mean age of patients with sepsis was 69(60,79)years.There were966 males(63.6%)and 570 females(36.4%).The APACHE II score was 19(14,25),and the SOFA score was 8(6,12),and the MODS score was 6(4,8).Lung,abdomen,chest were the most frequent sites of infection.Among the sepsis patients,889(57.8%)patients had lung infection,298(19.4%)had abdominal infection,101(6.6%)had chest infection,98(6.4%)had urinary infection,64(4.2%)had biliary infection,43(2.8%)had skin soft,tissue infection,16(1%)had pelvic infection,13(0.8%)had Central nervous infection,9(0.6%)had blood infection and 5(0.3%)was unknown.While the average age in the SIMD group was 70(63,80)years,which was 148(63.25%)males and 86(36.75%)females.The APACHE II score was 21(16,26),and the SOFA score was 9(7,12),and the MODS score was 6(4,9).Lung,abdomen and urinary were the most common sites of infection.In the SIMD group,156(66.7%)patients had lung infection,35(15%)had abdominal infection,14(5.9%)had urinary infection,12(5.1%)had biliary infection,10(4.3%)had chest infection,6(2.6%)had skin soft,tissue infections,and 1(0.4%)had central nervous infection.3 In the sepsis patients,compare the the death group and survival group,we found age,APACHE II score,SOFA score,MODS score,Lac,Scr,WBC,PCT and CRP in the death group were higher than that of survival group,and the difference was statistically significant(P<0.05).While oxygenation index,LVEF and ICU stay time in death group were less than that of the survival group,the difference was statistically significant(P<0.05).There were no significant differences in the TnI and mechanical ventilation time between the two groups(P>0.05).In the SIMD patients,Age,APACHE II score,SOFA score,MODS score,Lac,WBC,PCT,CRP in death group were higher than those in the survival group,and the difference was statistically significant(P<0.05).The LVEF of survival was higher than that in death group with statistically significant difference(P<0.05).Scr,oxygenation index,ICU stay time,TnI and mechanical ventilation time in the two groups were not statistically significant(P>0.05).4 Single-factor analysis showed that the SIMD,age,APACHEII score,SOFA score,MODS score,LVEF,Lac,WBC,PCT,CRP,SCR,and the length of ICU stay in sepsis had an effect on the prognosis(P<0.05).Multivariate Logistic regression analysis showed that the age,APACHE score,Lac and the PCT were independent prognostic factors.Single factor analysis showed that the age,APACHEII score,SOFA score,MODS score,LVEF,Lac,WBC,and PCT in SIMD had an effect on the prognosis(P < 0.05).PCT,APACHE II score were independent prognostic factors in SIMD.Conclusions: The incidence of sepsis was still high with 31.48%,which was the main reason for the increase of ICU mortality.The mortality rate of Sepsis-induced myocardial dysfunction(SIMD)was nearly 50%.Pulmonary infection and abdominal infection were predominant sources of sepsis and SIMD.SIMD did not affect the prognosis of sepsis.The age,APACHE II score,Lac and PCT were the independent risk factors for the prognosis of sepsis.While APACHE II score and PCT were independent risk factors for the prognosis of SIMD.