关键词: 脓毒症, 心室功能障碍, 预后

Abstract: Objective　 To investigate the value and clinical significance of using the ratio of early diastolic peak velocity and early diastolic flow velocity across the left atrioventricular valve （E/e'） for predicting the prognosis in sepsis.Methods　We selected 157 patients with sepsis enrolled from the First Affiliated Hospital of Xinjiang Medical University from March 2016 to May 2017.In accordance with the outcome within 28 days after the definite diagnosis of sepsis，we divided them into death group （39 cases） and survival group （118 cases）.We collected their clinical data，laboratory findings，acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score，sequential organ failure assessment （SOFA） score，results of echocardiogram performed within 24 hours after admission，E/e' determined by tissue Doppler imaging and so on.Multivariate Cox proportional hazards regression analysis was carried out to explore the associated factors for the prognosis of LVDD in sepsis.ROC curve analysis was implemented to investigate the value of E/e' for the prediction of the prognosis of LVDD in sepsis.Results　Compared with death group，the survival group had higher mean arterial pressure（MAP），oxygenation index（OI），Elat and Ea but less heart rate （HR），respiratory frequency（RF），NT-proBNP，blood lactate，hs-cTnT，PCT，APACHEⅡ score，SOFA score，E/e' sep，E/e' lat，and E/e' （P<0.05）.Moreover，the distribution of left ventricular diastolic function varied significantly between the survivals and the deaths （P<0.05）.Multivariate Cox proportional hazards regression analysis revealed that NT-proBNP〔HR=0.978，95%CI（0.967，0.989）〕，APACHEⅡ score〔HR=1.032，95%CI（1.009，1.054）〕，SOFA score〔HR=1.100，95%CI（1.050，1.153）〕，and E/e'〔HR=2.469，95%CI（2.071，2.867）〕were associated factors for the prognosis of sepsis （P<0.05）.For predicting the prognosis of sepsis，the AUC of E/e'〔AUC=0.887，95%CI（0.829，0.944）〕 was larger than that of NT-proBNP〔AUC=0.821，95%CI（0.743，0.898）〕，APACHEⅡ score〔AUC=0.604，95%CI（0.503，0.706）〕 and SOFA score〔AUC=0.705，95%CI（0.603，0.807）〕 （Z=1.631，P=0.050；Z=4.765，P=0.001；Z=3.057，P=0.001）.Conclusion　The LVDD in the deaths due to sepsis was more severe compared with those survivals.E/e' can be used to predict the prognosis of sepsis，and it is superior to NT-proBNP，APACHEⅡ score or SOFA score.

Key words: Sepsis, Ventricular dysfunction, Prognosis