The Prediction Of Survival Rate For The Critical Patients With Sepsis By Monitoring Cardiac Troponin Ⅰ Continuously

Background: Sepsis is considered to be a life-threatening organ dysfunction caused by an imbalance in the body’s response to infection.Myocardial injury is the most common cumulative complication of organ dysfunction in patients with sepsis,which is often accompanied by elevated cardiac troponin I,The purpose of this study is to analyze the influence of elevated c Tn I and its dynamic changes on their survival and prognosis in patients with severe sepsis,to reveal the high risk factors of patients with elevated cardiac troponin in severe sepsis,and to provide theoretical basis for early myocardial protection in patients with severe sepsis.Methods: The data of adult sepsis patients admitted to Fujian Provincial Hospital were collected for retrospective clinical study from January 2013 to December 2018.First,according to the first 24 hours c Tn I level of the first diagnosis of sepsis were divided into two groups: normal troponin group and elevated troponin group.Then,according to whether the level of c Tn I increased in the second 24 hours after entering ICU,the patients were divided into two groups: the group with dynamic increase of troponin and the group with dynamic decrease of troponin.According to the dynamic increase of c Tn I level and c Tn I level in the first 24 hours,the patients were divided into four groups:normal troponin group and dynamic decrease group,normal troponin group but dynamic increase group,troponin increase but dynamic decrease group,troponin increase and dynamic increase group.The measurement data were analyzed by t-test or nonparametric test,and the counting data were analyzed by Chi-Square test or Fisher exact test.In order to evaluate the effect of clinical data on the 28-day prognosis of patients with septic myocardial injury,we used univariate and multivariate Cox proportional hazard regression models to estimate HR(hazard ratio,risk ratios),and corrected the SOFA score to obtain the risk of death and protective factors in patients with septic myocardial injury.The entry method was used in univariate COX regression analysis,and the retrogression method was used in multivariate analysis for patients with single factor P <0.20.Results: There was no significant difference in mechanical ventilation time,28-day mortality,total hospital stay and ICU stay between normal troponin group and elevated troponin group in patients with ICU sepsis.Compared with the group with dynamic increase of troponin,the 28-day mortality in the dynamically decreased troponin group was significantly lower than that in the non-dynamically elevated group(29(26.1)%VS 24(47.1)%,P=0.009)but the length of hospital stay was significantly prolonged(26(14,45)d VS 21(11,30)d,P=0.048),but there was no significant difference in mechanical ventilation and ICU days.In the group with normal troponin and dynamic decrease of troponin,the duration of hospitalization in the group with elevated troponin and dynamic decrease was significantly longer than that in the group with dynamic increase of troponin(27(14,43.8)d VS 12(8,25.5)d,P=0.020;25(14,49)d VS12(8,25.5)d,P=0.026),but there was no significant difference in mechanical ventilation time,28-day mortality and ICU days among the four groups.After correcting SOFA score,COX multivariate regression analysis showed that troponin was normal but dynamically elevated(HR 2.315,95%CI(1.032,5.196),P=0.042*),troponin increased and increased dynamically(HR 3.343,95%CI(1.436,7.781),P=0.005*),age(HR1.023,95 % CI(1.004,1.043),P=0.015*),and Diabetes(HR 2.068,95 %CI(1.081,3.956),P=0.028*),neutrop Hil / lymp Hocyte count(HR 1.022,95 %CI(1.002,1.040),P=0.030*),C-reactive protein(HR 1.006,95%CI(1.003,1.009),P<0.001*),procalcitonin(HR 1.012,95%CI(1.006,1.019),P<0.001*),was a risk factor affecting the prognosis of patients with septic myocardial injury.Septic patients with dynamically elevated troponin in 28-day survival regression analysis had a higher risk of death.Conclusion: The incidence of elevated troponin in patients with severe sepsis is high,and the first 24 hours c Tn I level of the first diagnosis of sepsiss has no significant significance in predicting the mortality of patients with severe sepsis.the dynamic increase of troponin in the second 24 hours has obvious clinical significance in evaluating the prognosis of patients with severe sepsis.The dynamic increase of troponin in patients with high inflammatory index and diabetes mellitus has an increased risk of death in elderly patients with sepsis.Therefore,for patients with high risk of severe sepsis,cardiac troponin should be monitored continuously in early stage,myocardial protection treatment should be strengthened and the success rate of treatment should be improved.