| ObjectiveTo observe the predictive value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)and cystatin C(Cys C)in the diagnosis and prognosis of patients with sepsis myocardial depression。MethodsA prospective study was conducted to select 64 patients with sepsis from June 2016 to2017 in the Department of Critical Care Medicine.Plasma NT-proBNP and Cys C were detected on the 1d,3d,and 5d after admission,and abedside the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score were recored.Bedside color doppler ultrasonography was performed within 24 hours after admission,and recorded the left ventricular ejection fraction(EF).According to the 28 days survival situation,all patients were divided into survival group and death group,and respectively to compare the NT-proBNP,Cys C with APACHE Ⅱ grade and SOFA.According to EF numerical,the patients were divided into the sepsis myocardial dysfunction group(EF < 50%)and non-sepsis scheming dysfunction group(EF 50%),and compared the levels of NT-proBNP and Cys C in the two groups.Through the receiver-operating characteristic curve(ROC curve)to judge the NT-proBNP,Cys C,APACHE Ⅱ score and SOFA score of sepsis myocardial depression predictive value.Results(1)The APACHE Ⅱ score,SOFA score,and plasma PCT level were significantly higher in the death group(30 patients)than in the survival group(34 patients),and the difference was statistically significant(all p<0.05).(2)The NT-proBNP and Cys C in patients with sepsis myocardial depression were moderately correlated with APACHEⅡ and SOFA scores(r were 0.509 and 0.500,0.449 and 0.426,all p<0.05).(3)The plasma NT-proBNP and Cys C of 1.3.5d increased first and then decreased in the survival group,while those showed a continuous upward trend in the death group.There were statistically significant differences in the level of Cys C dynamic changes between the death group and the survival group(F=11.869,P=0.001).(4)There were 22 deaths in the 34 SIMD group,and the case fatality rate was 64.71%;This was higher than 26.67%(8/30)of the non-SIMD group.The difference was statistically significant(X2=9.253,P<0.01).(5)In the prediction of sepsis myocardial depression diagnosis,the P-values of the NT-proBNP,APACHE Ⅱ score,SOFA score and PCT are less than 0.05 according to the area under the ROC curve on the 1st and 3d.And the area of each indicator is compared with the area of 50% of the yellow line in the figure,the difference was statistically significant(P<0.05).The P value of Cys C area was greater than 0.05,the difference was not statistically significant.However,in terms of the diagnosis of myocardial depression in patients with sepsis at 5d,the optimal cutting point of NT-proBNP diagnosis was 3166.5pg/ml,with a sensitivity of 75% and a specificity of 80%,and the optimal cut point for Cys C diagnosis was 1.605mg/L,with a sensitivity of 71% and a specificity of 70%.ConclusionsDynamic monitoring of the NT-proBNP,Cys C,APACHE Ⅱ score,SOFA score helps to the evaluation of the severity of the sepsis patients with myocardial depression and prognosis;In predictive diagnosis of sepsis in patients with myocardial depression,NT-proBNP,APACHE Ⅱ score,SOFA score,PCT have higher predictive diagnostic value,and the Cys C predict early diagnosis value is low. |
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