Abstract：
OBJECTIVE: To investigate the predictive value of left ventricular global longitudinal peak strain (GLPS) for the prognosis of septic patients.
METHODS: A prospective cohort study was conducted. Patients diagnosed with sepsis and admitted to the intensive care unit (ICU) of the First Affiliated Hospital, Sun Yat-sen University from December 2018 to November 2019 were enrolled. The patient characteristics, cardiac ultrasound parameters [left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), four-dimensional ejection fraction (4DEF), GLPS] and cardiac biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT)] within 24 hours of ICU admission, organ support therapies, severity of illness, and prognostic indicators were documented. The differences in clinical parameters between patients with varying outcomes during ICU hospitalization were assessed. Pearson correlation analysis was employed to explore the correlation between GLPS and other cardiac systolic parameters, as well as the associations between various cardiac systolic parameters and sequential organ failure assessment (SOFA) score. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive capacity of cardiac ultrasound parameters and cardiac biomarkers for death during ICU hospitalization in septic patients.
RESULTS: A total of 50 septic patients were enrolled, with 40 surviving and 10 dying during ICU hospitalization, resulting in a mortality of 20.0%. All patients in the death group were male. Compared with the survival group, the patients in the death group were older, had a higher prevalence of diabetes mellitus, and received continuous renal replacement therapy (CRRT) more frequently, additionally, they exhibited more severe illness and had longer length of ICU stay. The levels of GLPS and cTnT in the death group were significantly elevated as compared with the survival group [GLPS: -7.1% (-8.5%, -7.0%) vs. -12.1% (-15.5%, -10.4%), cTnT (μg/L): 0.07 (0.05, 0.08) vs. 0.03 (0.02, 0.13), both P < 0.05]. However, no statistically significant difference was found in other cardiac ultrasound parameters or cardiac biomarkers between the two groups. Pearson correlation analysis revealed a negative correlation between GLPS and LVEF (r = -0.377, P = 0.014) and 4DEF (r = -0.697, P = 0.000), while no correlation was found with RVEF (r = -0.451, P = 0.069). GLPS demonstrated a positive correlation with SOFA score (r = 0.306, P = 0.033), while LVEF (r = 0.112, P = 0.481), RVEF (r = -0.134, P = 0.595), and 4DEF (r = -0.251, P = 0.259) showed no significant correlation with SOFA score. ROC curve analysis indicated that the area under the ROC curve (AUC) of GLPS for predicting death during ICU hospitalization in septic patients was higher than other cardiac systolic parameters, including LVEF, RVEF, and 4DEF, as well as cardiac biomarkers NT-proBNP and cTnT (0.737 vs. 0.628, 0.556, 0.659, 0.580 and 0.724). With an optimal cut-off value of -14.9% for GLPS, the sensitivity and negative predictive value reached to 100%.
CONCLUSIONS: GLPS < -14.9% within 24 hours of ICU admission in septic patients indicated a reduced risk of death risk during ICU hospitalization, while also correlating with the severity of organ dysfunction in this patient population.
METHODS: A prospective cohort study was conducted. Patients diagnosed with sepsis and admitted to the intensive care unit (ICU) of the First Affiliated Hospital, Sun Yat-sen University from December 2018 to November 2019 were enrolled. The patient characteristics, cardiac ultrasound parameters [left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), four-dimensional ejection fraction (4DEF), GLPS] and cardiac biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT)] within 24 hours of ICU admission, organ support therapies, severity of illness, and prognostic indicators were documented. The differences in clinical parameters between patients with varying outcomes during ICU hospitalization were assessed. Pearson correlation analysis was employed to explore the correlation between GLPS and other cardiac systolic parameters, as well as the associations between various cardiac systolic parameters and sequential organ failure assessment (SOFA) score. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive capacity of cardiac ultrasound parameters and cardiac biomarkers for death during ICU hospitalization in septic patients.
RESULTS: A total of 50 septic patients were enrolled, with 40 surviving and 10 dying during ICU hospitalization, resulting in a mortality of 20.0%. All patients in the death group were male. Compared with the survival group, the patients in the death group were older, had a higher prevalence of diabetes mellitus, and received continuous renal replacement therapy (CRRT) more frequently, additionally, they exhibited more severe illness and had longer length of ICU stay. The levels of GLPS and cTnT in the death group were significantly elevated as compared with the survival group [GLPS: -7.1% (-8.5%, -7.0%) vs. -12.1% (-15.5%, -10.4%), cTnT (μg/L): 0.07 (0.05, 0.08) vs. 0.03 (0.02, 0.13), both P < 0.05]. However, no statistically significant difference was found in other cardiac ultrasound parameters or cardiac biomarkers between the two groups. Pearson correlation analysis revealed a negative correlation between GLPS and LVEF (r = -0.377, P = 0.014) and 4DEF (r = -0.697, P = 0.000), while no correlation was found with RVEF (r = -0.451, P = 0.069). GLPS demonstrated a positive correlation with SOFA score (r = 0.306, P = 0.033), while LVEF (r = 0.112, P = 0.481), RVEF (r = -0.134, P = 0.595), and 4DEF (r = -0.251, P = 0.259) showed no significant correlation with SOFA score. ROC curve analysis indicated that the area under the ROC curve (AUC) of GLPS for predicting death during ICU hospitalization in septic patients was higher than other cardiac systolic parameters, including LVEF, RVEF, and 4DEF, as well as cardiac biomarkers NT-proBNP and cTnT (0.737 vs. 0.628, 0.556, 0.659, 0.580 and 0.724). With an optimal cut-off value of -14.9% for GLPS, the sensitivity and negative predictive value reached to 100%.
CONCLUSIONS: GLPS < -14.9% within 24 hours of ICU admission in septic patients indicated a reduced risk of death risk during ICU hospitalization, while also correlating with the severity of organ dysfunction in this patient population.
摘要：
目的：探讨左心室整体纵向峰值应变(GLPS)对脓毒症患者预后的预测价值。
方法：进行前瞻性队列研究。诊断为败血症并入住第一附属医院重症监护病房（ICU）的患者，中山大学于2018年12月至2019年11月入学。病人的特点,心脏超声参数[左心室射血分数（LVEF），右心室射血分数(RVEF),四维射血分数（4DEF），GLPS]和心脏生物标志物[N末端脑钠肽前体（NT-proBNP），心肌肌钙蛋白T（cTnT）]入住ICU后24小时内，器官支持疗法,疾病的严重程度,并记录预后指标。评估ICU住院期间具有不同结局的患者之间临床参数的差异。采用Pearson相关分析探讨GLPS与其他心脏收缩参数的相关性。以及各种心脏收缩参数与序贯器官衰竭评估（SOFA）评分之间的关联。绘制受试者特征曲线(ROC曲线),分析脓毒症患者ICU住院期间心脏超声参数和心脏生物标志物对死亡的预测能力。
结果：共纳入50例脓毒症患者，40人在ICU住院期间幸存，10人死亡，导致20.0%的死亡率。死亡组患者均为男性。与生存组相比，死亡组的患者年龄较大，糖尿病患病率较高，并更频繁地接受连续性肾脏替代疗法（CRRT），此外，他们表现出更严重的疾病，ICU住院时间更长。与存活组相比，死亡组的GLPS和cTnT水平显着升高[GLPS：-7.1％（-8.5％，-7.0%）与-12.1%（-15.5%，-10.4%），cTnT（μg/L）：0.07（0.05，0.08）与0.03(0.02,0.13),均P<0.05]。然而,两组间其他心脏超声参数或心脏生物标志物无统计学差异.Pearson相关分析显示GLPS与LVEF呈负相关(r=-0.377,P=0.014),4DEF呈负相关(r=-0.697,P=0.000)。与RVEF无相关性(r=-0.451,P=0.069)。GLPS与SOFA评分呈正相关(r=0.306,P=0.033),而LVEF(r=0.112,P=0.481),RVEF（r=-0.134，P=0.595），4DEF(r=-0.251,P=0.259)与SOFA评分无显著相关性。ROC曲线分析显示GLPS预测脓毒症患者ICU住院期间死亡的ROC曲线下面积(AUC)高于其他心脏收缩参数,包括LVEF,RVEF,和4DEF,以及心脏生物标志物NT-proBNP和cTnT（0.737vs.0.628、0.556、0.659、0.580和0.724)。GLPS的最佳截止值为-14.9%，敏感性和阴性预测值达到100%。
结论：脓毒症患者入住ICU后24小时内的GLPS<-14.9%表明ICU住院期间死亡风险降低，同时也与该患者人群中器官功能障碍的严重程度有关。
方法：进行前瞻性队列研究。诊断为败血症并入住第一附属医院重症监护病房（ICU）的患者，中山大学于2018年12月至2019年11月入学。病人的特点,心脏超声参数[左心室射血分数（LVEF），右心室射血分数(RVEF),四维射血分数（4DEF），GLPS]和心脏生物标志物[N末端脑钠肽前体（NT-proBNP），心肌肌钙蛋白T（cTnT）]入住ICU后24小时内，器官支持疗法,疾病的严重程度,并记录预后指标。评估ICU住院期间具有不同结局的患者之间临床参数的差异。采用Pearson相关分析探讨GLPS与其他心脏收缩参数的相关性。以及各种心脏收缩参数与序贯器官衰竭评估（SOFA）评分之间的关联。绘制受试者特征曲线(ROC曲线),分析脓毒症患者ICU住院期间心脏超声参数和心脏生物标志物对死亡的预测能力。
结果：共纳入50例脓毒症患者，40人在ICU住院期间幸存，10人死亡，导致20.0%的死亡率。死亡组患者均为男性。与生存组相比，死亡组的患者年龄较大，糖尿病患病率较高，并更频繁地接受连续性肾脏替代疗法（CRRT），此外，他们表现出更严重的疾病，ICU住院时间更长。与存活组相比，死亡组的GLPS和cTnT水平显着升高[GLPS：-7.1％（-8.5％，-7.0%）与-12.1%（-15.5%，-10.4%），cTnT（μg/L）：0.07（0.05，0.08）与0.03(0.02,0.13),均P<0.05]。然而,两组间其他心脏超声参数或心脏生物标志物无统计学差异.Pearson相关分析显示GLPS与LVEF呈负相关(r=-0.377,P=0.014),4DEF呈负相关(r=-0.697,P=0.000)。与RVEF无相关性(r=-0.451,P=0.069)。GLPS与SOFA评分呈正相关(r=0.306,P=0.033),而LVEF(r=0.112,P=0.481),RVEF（r=-0.134，P=0.595），4DEF(r=-0.251,P=0.259)与SOFA评分无显著相关性。ROC曲线分析显示GLPS预测脓毒症患者ICU住院期间死亡的ROC曲线下面积(AUC)高于其他心脏收缩参数,包括LVEF,RVEF,和4DEF,以及心脏生物标志物NT-proBNP和cTnT（0.737vs.0.628、0.556、0.659、0.580和0.724)。GLPS的最佳截止值为-14.9%，敏感性和阴性预测值达到100%。
结论：脓毒症患者入住ICU后24小时内的GLPS<-14.9%表明ICU住院期间死亡风险降低，同时也与该患者人群中器官功能障碍的严重程度有关。
