| Objective:Conventional echocardiography may not detect subtle cardiac dysfunction of patients with sepsis or septic shock.Left ventricular(LV)Global Longitudinal Strain(GLS)can detect early cardiac dysfunction.This study aimed to investigate the influence of left ventricular global longitudinal strain on clinical prognosis of Patients with sepsis or septic Shock.Methods:Using a prospective cohort study,64 patients with sepsis or septic shock admitted to the department of of Intensive Care Unit,Hwa Mei Hospital,university of Chinese academy of sciences,from November 2018 to December 2019 were enrolled in this study.The Global Longitudinal Strain(GLS)of the patients’ left ventricle was detected by Speckle Tracking Echocardiography(STE)at the time of enrollment,and the patients were divided into GLS >-20%group(low-Strain group)and GLS≤-20% group(high-Strain group)according to the Strain value.Various parameters were recorded for every patient in each group,including general information,acute physiology and chronic health evaluation II(APACHE II)score,sequential organ failure score(SOFA),and total fluid volume,urine volume per hour within 24 hours of diagnosis.The proportion of vasoactive agents use,mechanical ventilation and renal replacement therapy were recorded in both groups.Blood lactate level,Scv O2,oxygenation index(Pa O2/Fi O2),some index reflects other organ function including heart、liver、kidney etc,and parameters in Transthoracic echocardiography(TTE)examination were recorded at the time of enrollment.The left ventricular GLS of the two groups of patients were detected by STE technology.We draw Kaplan-Meier survival curve to evaluate the differences of 28 d survival rate between the two groups,and taken pearson correlation analysis to assess the relationship between GLS and index for tissue perfusion or organ function.Univariate and multivariate Cox regression analysis were used to assess the prognostic value of all potential variables for predicting 28-day mortality.At the same time,subgroup analysis was conducted on the included patients with sepsis and septic shock,and the differences of routine cardiac ultrasound parameters and GLS between the two groups were compared.Results:(1)64 patients with sepsis or septic shock were included in this study,including 39patients(60.9%)in the low-strain group and 25 patients(39.1%)in the high-strain group.Compared with the high-strain group,the survival rate in the low-strain group was significantly lower [56.4%(22/39)vs.80%(20/25),P=0.038].(2)The acute physiology and chronic health evaluation II(APACHE II)score(20.5±7.1 points vs 15.88±4.9 points,P=0.003),sequential organ failure score(SOFA)(8.7±3.2 points vs 6.8±2.9 points,P=0.024)and the proportion of noradrenaline use [69.2%(27/39)vs 32.0%(8/25),P=0.004] in the low-strain group were significantly higher than those in the high-strain group at the time of enrollment.Scv O2(65.3 ±4.4% vs 69.2 ± 5.3%,P = 0.002)and urine output per hour(0.817 ± 0.587 ml.kg-1.h-1 vs 1.196± 0.516 ml.kg-1.h-1,P = 0.010)in the low-strain group were lower than those in the high-strain group,but there was no significant difference in blood lactate level and total volume in 24 hours between the two groups(P> 0.05).(3)In terms of organ function assessment,the serum level of Scr(143.3 ± 25.9 umol / L vs 127.2 ± 27.6umol / L,P = 0.021)and BUN(13.7 ± 6.8 mmol / L vs8.6 ± 4.0 mmol / L,P <0.001)which can reflects renal function were significantly higher in the low-strain group than in the high-strain group,but the serum level of NT-Pro BNP、c TNI、AST、ALT、TBIL、DBIL、Alb、blood platelet、and Pa O2 / Fi O2 were not statistically different between the two groups(all P> 0.05).(4)Compared with the high-strain group,the GLS value of the low-strain group is higher(-13.77 ± 2.35% vs-21.64 ± 1.44%,P <0.001),which indicates that left ventricular systolic function is worse.In terms of conventional echocardiographic parameters,including LVEF、LVEDV、LVESV、SV、CO and CI,there was no statistical difference between two groups.It is suggested that STE is more sensitive than conventional echocardiography in detecting systolic dysfunction in patients with sepsis or septic shock.(5)GLS at time of enrollment was significantly,negatively correlated with Scv O2、LVEF and urine output per hour(r =-0.424,P <0.001;r =-0.293 P = 0.019;r =-0.334,P = 0.007),and was significantly,postively correlated with SCr(r = 0.350,P = 0.005)、BUN(r = 0.378,P =0.002).Multivariate Cox regression analysis showed that GLS(HR=1.222,95%CI:1.050-1.423,P=0.01)、LAC(HR=1.501,95%CI:1.199-1.878,P<0.001)、APACHEIII score(HR=1.096,95%CI :1.013-1.185,P=0.022)were independent risk factors for 28-day mortality of patients with sepsis or septic shock.The optimal cutoff point of GLS for predicting 28-day mortality was-13.5%with a sensibility of 59.1% and specificity of 97.6%,the area under curve(AUC)was 0.831.The optimal cutoff point of GLS for predicting 28-day mortality was-13.5% with a sensibility of86.4% and specificity of76.2%,the area under curve(AUC)was 0.852.The optimal cutoff point of APACHEII score for predicting 28-day mortality was 18.5 mmol/L with a sensibility of 77.3% and specificity of73.8%,the area under curve(AUC)was 0.808.(6)Subgroup analysis showed that left ventricular systolic function was easily affected in patients with sepsis and septic shock,and left ventricular GLS(-15.5 ± 4.0% vs-18.5 ± 4.3%,P = 0.004)was significantly higher in patients with septic shock.Conclutions:1.The left ventricular global longitudinal strain has the value of predicting the 28-day mortality rate of sepsis or septic shock,and is a good predictor of the prognosis of sepsis or septic shock.2.Speckle Tracking Echocardiography is more sensitive than conventional echocardiography in detecting systolic dysfunction in patients with sepsis or septic shock.3.Left ventricular systolic function is easily impaired in patients with sepsis and septic shock,and left ventricular systolic function is more severe in patients with septic shock than in patients with sepsis. |
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