Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and some sepsis patients will develop cardiac dysfunction. Sepsis-induced cardiac dysfunction (SICD) has been demonstrated to be a promising predictor of mortality, although the prediction of SICD itself remains unclear. Clinical studies have shown that soluble CD14 subtype (sCD14-ST) may be a useful predictor for sepsis. In this study, we aimed to evaluate the predictive value of sCD14-ST for SICD in patients with sepsis.
Patients with SICD from three intensive care units (ICUs) of three medical centers between January 2015 and December 2018 were enrolled. Clinical data and information were collected from hospital and clinic records. Blood samples at admission were collected and serum levels of sCD14-ST were tested. Patients were followed up for at least 1 year. Major adverse cardiovascular events (MACEs) were recorded. Echocardiography was repeated at the end of 1-year follow-up.
A total of 117 patients were enrolled into the final analysis. During 1-year follow-up, MACEs occurred in 35 (29.9%) patients. Most MACEs occurred with 3 months after discharge. Univariate and multivariate analysis revealed that age (OR =1.5, 95% CI: 1.2-2.3, P=0.036), cardiac troponin T (cTnT) (OR =1.4, 95% CI: 1.2-2.1, P=0.027), creatine (Cr) (OR =1.6, 95% CI: 1.3-2.5, P=0.022), sequential organ failure assessment (SOFA) score (OR =1.7, 95% CI: 1.3-2.6, P=0.012), and soluble cluster of differentiation 14 subtype (sCD14-ST) (OR =1.9, 95% CI:1.4-3.1, P=0.015) were predictors for MACEs in patients with SICD at 1-year follow-up. Area under receiver operating curve (AUROC) of sCD14-ST to MACEs was 0.784, and the cutoff point was 748.3 μg/L with a sensitivity of 0.78 and a specificity of 0.74 respectively. Blood test at the end of 1-year follow-up revealed that patients with a lower sCD14-ST level had better lower Cr, N-terminal pro-brain natriuretic peptide (NT-proBNP) and higher systolic blood pressure (SBP) and left ventricular ejection fraction (LVEF).
MACEs mainly occurred within 3 months after discharge in patients with SICD, and high baseline serum levels of sCD14-ST predicted poor prognosis in patients with SICD.