Elevated plasma histone is an independent risk factor for the development of septic cardiomyopathy
10.3760/cma.j.issn.2095-4352.2019.12.005
- VernacularTitle: 高血浆组蛋白是脓毒症心肌病发生的独立危险因素
- Author:
Nianfang LU
1
,
2
;
Bo ZHU
3
;
Degang YANG
4
;
Ruiqiang ZHENG
5
;
Jun SHAO
5
;
Xiuming XI
3
Author Information
1. Department of Critical Care Medicine, Beijing Electric Power Hospital, Beijing 100073, China
2. Department of Critical Care Medicine, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yangzhou 225001, Jiangsu, China
3. Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China
4. Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China
5. Department of Critical Care Medicine, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yangzhou 225001, Jiangsu, China
- Publication Type:Journal Article
- Keywords:
Histone;
Cardiac troponin;
Sepsis;
Septic cardiomyopathy;
Independent risk factor
- From:
Chinese Critical Care Medicine
2019;31(12):1457-1461
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the epidemiology and independent risk factors of septic cardiomyopathy.
Methods:A prospective study was conducted. Patients with sepsis in intensive care unit (ICU) of Subei People's Hospital of Jiangsu Province, Yangzhou University, Fuxing Hospital, Capital Medical University and Beijing Electric Power Hospital from May 2016 to August 2019 were enrolled. All patients received standardized treatments according to the Surviving Sepsis Campaign (SSC) guidelines. Blood were collected within 24 hours of admission to ICU, and plasma histone H4, cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were detected by enzyme linked immunosorbent assay (ELISA). Transthoracic echocardiography was performed to record the ultrasonic parameters within 24 hours after admission. Sequential organ failure assessment (SOFA) score, usage of vasopressor drugs, and the prognosis of ICU were recorded. Patients were divided into two groups according to whether cardiomyopathy occurred or not, and the differences of each index between the two groups were compared. The correlation between plasma histone H4 and SOFA score, cTnI, NT-proBNP were investigated. Multivariate binary Logistic regression was used to determine the risk factors for septic cardiomyopathy. The predictive value of histone H4 in septic cardiomyopathy was shown by the receiver operating characteristic (ROC) curve.
Results:121 patients were included in this study, and there were 60 patients (49.6%) with septic cardiomyopathy. Thirty-six patients died, with an ICU mortality of 29.8%. ① Correlation analysis showed that plasma histone H4 in patients with septic cardiomyopathy was positively correlated with cTnI, SOFA score and NT-proBNP (r value was 0.512, 0.403 and 0.274, respectively, all P < 0.01). ② Compared with the non-cardiomyopathy group, the plasma histone H4, cTnI, usage of vasopressor drugs, SOFA score and ICU mortality in the cardiomyopathy group were significantly increased [histone H4 (mg/L): 0.26 (0.23, 0.30) vs. 0.22 (0.17, 0.27), cTnI (μg/L): 0.21 (0.17, 0.30) vs. 0.18 (0.14, 0.22), usage of vasopressor drugs: 83.3% (50/60) vs. 65.6% (40/61), SOFA score: 11 (9, 12) vs. 9 (8, 10), ICU mortality: 40.0% (24/60) vs. 19.7% (12/61), all P < 0.05]. Multivariate binary Logistic regression analysis showed that high histone H4 level [odds ratio (OR) = 6.502, 95% confidence interval (95%CI) was 1.203-78.231, P = 0.044] and usage of vasopressor drugs (OR = 2.622, 95%CI was 1.034-6.849, P = 0.042) were independent risk factors for septic cardiomyopathy. ④ ROC curve analysis showed the cut-off of histones H4 for predicting septic cardiomyopathy was 0.24 mg/L, the area under the curve was 0.684 (P < 0.01), with the sensitivity of 65.2%, and specificity of 68.9%.
Conclusions:Septic cardiomyopathy had a high incidence. Higher plasma histone H4 and the usage of vasopressor drugs were independent risk factors for septic cardiomyopathy.
