Value of echocardiography combined with biomarkers in diagnosing and prognosticating of myocardial injury in sepsis
HE Dan-na
ZHAO Rui-ping
LI Wei
HU Jun
YANG Yang
SONG Xiu-rong
Abstract：Objective To investigate the clinical value of echocardiography combined with serum nicotinamide adenine dinucleotide phosphate oxidase(NOX2)and secretory frizzled-related protein 5(SFRP5)in diagnosing and prognosing myocardial injury in sepsis.Methods A total of 400 patients diagnosed with sepsis and admitted to Baotou Central Hospital between February 2020 and May 2023 were selected for this study.Patients were categorized into an injury group(n=173)and a non-injury group(n=227)based on the presence or absence of concomitant myocardial injury.Additionally,they were divided into a mortality group(n=65)and a survival group(n=108)based on their prognosis after 28 days of treatment.Serum NOX2 and SFRP5 expression levels were measured using ELISA.Pearson's correlation analysis was performed to assess the relationship between serum NOX2 and SFRP5 levels and echocardiographic parameters.ROC curve analysis was conducted to assess the diagnostic and prognostic value of echocardiographic parameters alongside serum NOX2 and SFRP5,both individually and in combination,for assessing myocardial injury in septic patients.Lasso-Cox regression analysis was used to identify factors associated with mortality in patients with septic myocardial injury.Results Compared to the non-injury group,the injury group had a larger LAD and LVEDD,along with elevated levels of serum NOX2[(145.39±22.85)pg/ml vs.(118.27±21.46)pg/ml],C-reactive protein,procalcitonin,cardiac troponin I,and creatine kinase-MB.LVEF and serum SFRP5[(37.08±6.65)ng/ml vs.(45.15±7.93)ng/ml]levels were significantly reduced(P<0.05).Serum NOX2 levels showed a negative correlation with LVEF and a positive correlation with LVEDD and LAD.Serum SFRP5 levels exhibited a positive correlation with LVEF and a negative correlation with LVEDD and LAD(P<0.001).The area under the curve(AUC)values for LVEF,LVEDD,and LAD in diagnosing myocardial injury in septic patients were 0.894,0.908,and 0.752 respectively,while those for serum NOX2 and SFRP5 were 0.862 and 0.874 respectively.The combined diagnostic AUC was 0.987,indicating superior diagnostic value(P<0.001).Compared with the survival group,the mortality group had a larger LAD,LVEDD,higher APACHE scores,and elevated levels of serum NOX2[(166.51±25.82)pg/ml vs.(132.68±21.06)pg/ml],procalcitonin,cardiac troponin I,and creatine kinase-MB.LVEF and decreased serum SFRP5 levels[(30.67±5.32)ng/ml vs.(40.93±7.45)ng/ml]were significantly lower(P<0.05).The results of the Lasso-Cox regression analysis identified CK-MB,LVEDD,LAD,and NOX2 as all risk factors for mortality in patients with septic myocardial injury,while LVEF and SFRP5 were found to be protective factors(P<0.05).The AUCs for LVEF,LVEDD,LAD,NOX2,and SFRP5 in predicting mortality were 0.917,0.890,0.859,0.845,and 0.857 respectively.The combined predictive AUC was 0.984,indicating superior predictive value for the combined assessment(P<0.001).Conclusions Patients with sepsis complicated by myocardial injury exhibit elevated serum NOX2 levels and reduced SFRP5 levels.The combination of echocardiographic parameters with serum NOX2 and SFRP5 demonstrates significant clinical value in diagnosing sepsis-associated myocardial injury and assessing its prognosis.
Keywords：Myocardial injurySepsisEchocardiographyNicotinamide adenine dinucleotide phosphate oxidase 2Secreted frizzled-related protein 5
Publication Date：2026-02-25
Online Publishing Date：2026-03-16(First online date of this platform, not the publication date of the document)
Pages：7( 133-139 )