重症合并感染患者的超声心动图特征及其对28d死亡和心肌损伤的预测价值OA
Echocardiographic features of critically ill patients with concurrent infections and their predictive value for 28-day mortality and cardiac injury
目的 探讨重症合并感染患者的超声心动图特征,以及超声参数对患者 28 d死亡和心肌损伤的预测价值.方法 采用单中心前瞻性队列设计,连续纳入 2024年 1月至 2025年 1月复旦大学附属金山医院重症医学科收治的重症合并感染患者 120 例,依据感染程度分为脓毒症组(n=75)与非脓毒症组(n=45).采用 Cox比例风险模型及改良Poisson回归模型分析患者 28 d全因死亡和心肌损伤的危险因素,Kaplan-Meier生存曲线及 log-rank检验分析不同超声参数患者的预后差异.采用 ROC曲线及曲线下面积(area under the curve,AUC)评价超声参数的预测效能,限制性立方样条(restricted cubic spline,RCS)模型分析非线性关系.结果 脓毒症组 E/e'比值显著高于非脓毒症组(P＜0.001),左心室射血分数(left ventricular ejection fraction,LVEF)、左心室短轴缩短率(left ventricular fractional shortening,LVFS)低于非脓毒症组(P＜0.05).Cox比例风险模型未发现超声参数与 28 d全因死亡的关联.改良 Poisson回归显示,校正混杂因素后,E/e'比值升高是心肌损伤的独立危险因素(RR=1.12,95%CI 1.07～1.17,P＜0.001).生存分析显示,E/e'＞10.9的患者 28 d生存率更低(P=0.02),E/e'预测心肌损伤的 AUC为 0.835.RCS分析提示 E/e'与心肌损伤风险非线性相关(P＜0.001).结论 E/e'、LVEF、LVFS对重症合并感染患者 28 d死亡无预测价值.E/e'比值升高是重症合并感染并发心肌损伤的独立危险因素,且二者非线性相关.
Objective To explore the echocardiographic features of critically ill patients with infection,and to evaluate the predictive value of echocardiographic parameters for 28-day mortality and myocardial injury.Methods Using a single-center prospective cohort design,120 critically ill patients with infection admitted to the Intensive Care Unit,Jinshan Hospital of Fudan University from January 2024 to January 2025 were enrolled consecutively.According to the severity of infection,patients were divided into the sepsis group(n=75)and the non-sepsis group(n=45).Cox proportional hazards models and modified Poisson regression were used to analyze risk factors of 28-day all-cause mortality and myocardial injury.Kaplan-Meier survival curve and log-rank test were used to assess prognosis differences among patients with different ultrasound parameters.ROC curve and area under the curve(AUC)were applied to evaluate the predictive performance of ultrasound parameters,and restricted cubic spline(RCS)model was used to explore nonlinear relationships.Results The E/e' ratio was significantly higher in the sepsis group than in the non-sepsis group(P＜0.001),while left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)were lower in the sepsis group(P＜0.05).The Cox proportional hazards model found no association between ultrasound parameters and 28-day all-cause mortality.Modified Poisson regression showed that,after adjusting for confounding factors,elevated E/e' was an independent risk factor of myocardial injury(RR=1.12,95%CI 1.07-1.17,P＜0.001).Survival analysis demonstrated that patients with E/e'＞10.9 had lower 28-day survival rates(P=0.02),and the AUC for E/e' predicting myocardial injury was 0.835.RCS analysis suggested a nonlinear relationship between E/e' and myocardial injury risk(P＜0.001).Conclusions E/e',LVEF,and LVFS have no significant predictive value for 28-day mortality risk in critically ill patients with infections.Elevated E/e' is an independent risk factor of myocardial injury in such patients,with a nonlinear relationship.
郭朋;周瑜珊;王一冰;张志华;申捷;莫为春
复旦大学附属金山医院急危重病中心,上海 201508上海市张堰镇社区卫生服务中心全科医学科,上海 201500复旦大学附属金山医院急危重病中心,上海 201508复旦大学附属金山医院超声医学科,上海 201508复旦大学附属金山医院急危重病中心,上海 201508复旦大学附属金山医院急危重病中心,上海 201508
医药卫生
重症患者感染脓毒症E/e'28d全因死亡心肌损伤
critically ill patientinfectionsepsisE/e' ratio28-day all-cause mortalitymyocardial injury
《中国临床医学》 2026 (3)
414-423,10
上海市卫生健康委员会科研项目(20254Y0015),上海市公共卫生研究专项(2025GKM22),上海市金山区卫健系统第五周期"优秀青年人才"培养计划(JSYQ202301).Supported by Research Project of Shanghai Municipal Health Commission(20254Y0015),Special Program for Public Health Research of Shanghai(2025GKM22),and Jinshan District Health System Fifth-Cycle Outstanding Young Talent Program(JSYQ202301).
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