Predictive value of non-invasive hemodynamic monitoring by bioelectrical impedance analysis in neonatal sepsis complicated with cardiac dysfunction

doi:10.3877/cma.j.issn.1673-5250.2022.02.014

Objective

To explore value of non-invasive hemodynamic monitoring by bioelectrical impedance analysis (NHM-BIA) in predicting neonatal sepsis (NS) complicated with cardiac dysfunction (CD).

Methods

A total of 152 children with NS who were admitted to neonatal intensive care unit (NICU) of Affiliated Children′s Hospital of Xi′an Jiaotong University from January 2017 to November 2020 were selected as research subjects. They were divided into study group (n=53, complicated with CD) and control group (n=99, without CD) according to whether they were complicated with CD or not by retrospective analysis method. The gender, gestational age at birth, weight at birth, proportion of critically ill neonates, serum N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitive cardiac troponin (hs-cTn), and creatine kinase isoenzyme MB (CK-MB), atrial and ventricular diameter and ejection fraction, as well as heart rate, stroke volume index (SI), cardiac output (CO), cardiac index, stroke volume variability (SVV), flow time of corrected (FTC), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), index of contractility (ICON), systolic time ratio (STR) of two groups were compared by independent-samples t test, Mann-Whitney U test and chi-square test. Multivariate unconditional logistic regression analysis was used to analyze the influencing factors of NS complicated with CD in neonates. Receiver operating characteristics (ROC) curves of different indexes of NHM-BIA to predict NS complicated with CD were drawn, and area under the curve (AUC) was calculated. According to principle of maximum Youden index, the best critical value of different indexes for predicting NS complicated with CD were determined. The procedures followed in this study met the standards formulated by the Ethics Review Committee of Affiliated Children′s Hospital of Xi′an Jiaotong University and has been approved by it (Approval No. 20210034). There were no significant differences in general clinical data of neonates with NS between two groups, such as gender composition ratio, gestational age and weight at birth (P>0.05).

Results

①The proportion of critically ill neonates and serum levels of NT-proBNP and hs-cTn in study group were significantly higher than those in control group, and the differences were statistically significant (P<0.05). ②Heart rate, SVV, SVR, SVRI and STR of neonates with NS in study group were significantly higher than those in control group, while SI, cardiac index, FTC, and ICON were significantly lower than those in control group, and all differences were statistically significant (P<0.05). ③Multivariate unconditional logistic regression analysis showed that high serum levels of NT-proBNP and hs-cTn were independent risk factors for NS neonates complicated with CD (OR=1.001, 1.095; 95%CI: 1.000-1.001, 1.047-1.146, all P<0.001), while high cardiac index was an independent protective factor for NS neonates complicated with CD (OR=0.075, 95%CI: 0.022-0.253, P<0.001). ④AUC of serum levels of NT-proBNP and hs-cTn, cardiac index and three indexes combined to predict of NS neonates complicated with CD were 0.814 (95%CI: 0.734-0.894, P<0.001), 0.858 (95%CI: 0.784-0.931, P<0.001), 0.925 (95%CI: 0.784-0.931, P<0.001), and 0.975 (95%CI: 0.942-1.000, P<0.001), respectively. According to principle of maximum Youden index, the best critical values of serum levels of NT-proBNP and hs-cTn and cardiac index for predicting CD in neonates with NS were 13 355 ng/L, 74 ng/L, and 2.74 L/(min·m²), the sensitivities of serum levels of NT-proBNP and hs-cTn, cardiac index and three indexes combined were 77.4%, 58.5%, 84.9%, and 81.1%, respectively, and the specificities were 73.6%, 95.4%, 93.1%, and 96.6%, respectively.

Conclusions

NHM-BIA can effectively monitor hemodynamic changes in neonates with NS complicated with CD. Cardiac index combined with serum levels of NT-proBNP and hs-cTn has high predictive value in NS neonates complicated with CD.

Key words: Sepsis, Cardiac dysfunction, Hemodynamics, Non-invasive hemodynamic monitoring, Bioelectrical impedance analysis, Natriuretic peptide, brain, Troponin, Infant, newborn

表1 2组NS患儿相关临床资料比较

组别	例数	性别[例数(%)]		出生胎龄(周，±s)	出生体重(kg，±s)	危重新生儿[例数(%)]	WBC[×10⁹/L，M(P₂₅~P₇₅)]	PLT[×10⁹/L，M(P₂₅~P₇₅)]	血清CRP[×10⁹/L，M(P₂₅~P₇₅)]
组别	例数	男	女	出生胎龄(周，±s)	出生体重(kg，±s)	危重新生儿[例数(%)]	WBC[×10⁹/L，M(P₂₅~P₇₅)]	PLT[×10⁹/L，M(P₂₅~P₇₅)]	血清CRP[×10⁹/L，M(P₂₅~P₇₅)]
研究组	53	39(73.6)	14(26.4)	35.7±1.1	2.52±0.64	50(94.3)	7.4(7.1~8.1)	188.0(118.4~237.6)	6.7(3.6~21.5)
对照组	99	60(60.6)	39(39.4)	35.4±1.2	2.54±0.81	60(60.6)	7.5(7.2~8.2)	195.0(123.6~284.2)	6.8(2.7~22.4)
检验值		χ²＝2.560		t＝-0.147	t＝-0.448	χ²＝6.216	Z＝-0.320	Z＝-0.883	Z＝-0.253
P值		0.110		0.883	0.655	0.013	0.749	0.377	0.800
组别	例数	血清hs-cTn(ng/L，±s)	血清NT-proBNP(ng/L，±s)	血清CK-MB(mmol/L，±s)	UCG(±s)
组别	例数	血清hs-cTn(ng/L，±s)	血清NT-proBNP(ng/L，±s)	血清CK-MB(mmol/L，±s)	左心室内径(mm)	左心房内径(mm)	右心室内径(mm)	右心房内径(mm)	射血分数(%)
研究组	53	74.5±27.3	12 234.0±4 894.1	142.7±35.2	13.7±2.3	10.1±1.6	8.8±2.3	14.45±3.05	60.5±9.3
对照组	99	40.8±13.3	7 969.0±2 777.8	137.4±31.6	14.4±2.7	10.8±1.9	8.6±1.8	15.05±2.36	66.6±3.7
检验值		t＝9.522	t＝8.011	t＝1.558	t＝1.392	t＝1.416	t＝1.039	t＝0.801	t＝0.637
P值		<0.001	<0.001	0.122	0.167	0.160	0.301	0.425	0.525

表1 2组NS患儿相关临床资料比较

组别	例数	性别[例数(%)]		出生胎龄(周，±s)	出生体重(kg，±s)	危重新生儿[例数(%)]	WBC[×10⁹/L，M(P₂₅~P₇₅)]	PLT[×10⁹/L，M(P₂₅~P₇₅)]	血清CRP[×10⁹/L，M(P₂₅~P₇₅)]
组别	例数	男	女	出生胎龄(周，±s)	出生体重(kg，±s)	危重新生儿[例数(%)]	WBC[×10⁹/L，M(P₂₅~P₇₅)]	PLT[×10⁹/L，M(P₂₅~P₇₅)]	血清CRP[×10⁹/L，M(P₂₅~P₇₅)]
研究组	53	39(73.6)	14(26.4)	35.7±1.1	2.52±0.64	50(94.3)	7.4(7.1~8.1)	188.0(118.4~237.6)	6.7(3.6~21.5)
对照组	99	60(60.6)	39(39.4)	35.4±1.2	2.54±0.81	60(60.6)	7.5(7.2~8.2)	195.0(123.6~284.2)	6.8(2.7~22.4)
检验值		χ²＝2.560		t＝-0.147	t＝-0.448	χ²＝6.216	Z＝-0.320	Z＝-0.883	Z＝-0.253
P值		0.110		0.883	0.655	0.013	0.749	0.377	0.800
组别	例数	血清hs-cTn(ng/L，±s)	血清NT-proBNP(ng/L，±s)	血清CK-MB(mmol/L，±s)	UCG(±s)
组别	例数	血清hs-cTn(ng/L，±s)	血清NT-proBNP(ng/L，±s)	血清CK-MB(mmol/L，±s)	左心室内径(mm)	左心房内径(mm)	右心室内径(mm)	右心房内径(mm)	射血分数(%)
研究组	53	74.5±27.3	12 234.0±4 894.1	142.7±35.2	13.7±2.3	10.1±1.6	8.8±2.3	14.45±3.05	60.5±9.3
对照组	99	40.8±13.3	7 969.0±2 777.8	137.4±31.6	14.4±2.7	10.8±1.9	8.6±1.8	15.05±2.36	66.6±3.7
检验值		t＝9.522	t＝8.011	t＝1.558	t＝1.392	t＝1.416	t＝1.039	t＝0.801	t＝0.637
P值		<0.001	<0.001	0.122	0.167	0.160	0.301	0.425	0.525

表2 2组NS患儿NHM-BIA指标比较(±s)

组别	例数	心率(次/min)	SI[L/(min·m²)]	心指数[L/(min·m²)]	SVV(%)	FTC(ms)	SVR(dyn·s/cm⁵)	SVRI[dyn·s/(cm⁵·m²)]	ICON	STR
研究组	53	150.5±18.9	16.7±2.3	2.4±0.6	26.7±3.3	168.6±23.0	8 237.2±725.4	1 938.5±274.9	52.7±9.2	0.67±0.16
对照组	99	144.1±16.3	24.7±2.3	3.6±0.7	15.8±2.3	248.5±23.3	6 463.4±536.3	1 145.6±227.6	74.8±14.4	0.46±0.09
t值		2.140	-19.158	-10.198	22.917	-19.799	10.452	18.457	-10.450	13.897
P值		0.034	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表2 2组NS患儿NHM-BIA指标比较(±s)

组别	例数	心率(次/min)	SI[L/(min·m²)]	心指数[L/(min·m²)]	SVV(%)	FTC(ms)	SVR(dyn·s/cm⁵)	SVRI[dyn·s/(cm⁵·m²)]	ICON	STR
研究组	53	150.5±18.9	16.7±2.3	2.4±0.6	26.7±3.3	168.6±23.0	8 237.2±725.4	1 938.5±274.9	52.7±9.2	0.67±0.16
对照组	99	144.1±16.3	24.7±2.3	3.6±0.7	15.8±2.3	248.5±23.3	6 463.4±536.3	1 145.6±227.6	74.8±14.4	0.46±0.09
t值		2.140	-19.158	-10.198	22.917	-19.799	10.452	18.457	-10.450	13.897
P值		0.034	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表3 NS患儿并发CD影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
血清NT-proBNP水平	<0.001	<0.001	13.582	<0.001	1.001	1.000~1.001
血清hs-cTn水平	0.091	0.023	15.458	<0.001	1.095	1.047~1.146
心指数	-2.592	0.621	17.417	<0.001	0.075	0.022~0.253
心率	0.035	0.021	2.661	0.103	1.036	0.993~1.080
SI	-0.376	0.335	1.261	0.262	0.687	0.356~1.324
SVV	-0.702	1.508	0.217	0.642	0.496	0.026~9.517
FTC	5.257	9.977	0.278	0.598	19.811	0.001~5.960
SVR	2.826	2.145	1.735	0.188	16.872	0.252~11.32
SVRI	-0.015	0.026	0.323	0.570	0.985	0.936~1.037
ICON	-0.002	0.011	0.039	0.843	0.998	0.976~1.020
STR	-1.537	3.054	0.253	0.615	0.215	0.001~54.321
常数项	-6.244	3.512	3.162	0.075	0.002	—

表3 NS患儿并发CD影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
血清NT-proBNP水平	<0.001	<0.001	13.582	<0.001	1.001	1.000~1.001
血清hs-cTn水平	0.091	0.023	15.458	<0.001	1.095	1.047~1.146
心指数	-2.592	0.621	17.417	<0.001	0.075	0.022~0.253
心率	0.035	0.021	2.661	0.103	1.036	0.993~1.080
SI	-0.376	0.335	1.261	0.262	0.687	0.356~1.324
SVV	-0.702	1.508	0.217	0.642	0.496	0.026~9.517
FTC	5.257	9.977	0.278	0.598	19.811	0.001~5.960
SVR	2.826	2.145	1.735	0.188	16.872	0.252~11.32
SVRI	-0.015	0.026	0.323	0.570	0.985	0.936~1.037
ICON	-0.002	0.011	0.039	0.843	0.998	0.976~1.020
STR	-1.537	3.054	0.253	0.615	0.215	0.001~54.321
常数项	-6.244	3.512	3.162	0.075	0.002	—

图1 血清NT-proBNP、hs-cTn水平与心指数及3项指标联合预测NS患儿并发CD的ROC曲线注：NT-proBNP为脑利钠肽前体，hs-cTn为高敏肌钙蛋白，NS为新生儿脓毒症，CD为心功能障碍。ROC曲线为受试者工作特征曲线

表4 血清NT-proBNP、hs-cTn水平与心指数及3项指标联合预测NS患儿并发CD的ROC曲线分析结果

指标	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)	约登指数
血清NT-proBNP水平(ng/L)	0.814	0.734~0.894	<0.001	13 355	77.4	73.6	0.510
血清hs-cTn水平(ng/L)	0.858	0.784~0.931	<0.001	74	58.5	95.4	0.539
心指数[L/(min·m²)]	0.925	0.877~0.973	<0.001	2.74	84.9	93.1	0.780
上述3项指标联合	0.975	0.942~1.000	<0.001	—	81.1	96.6	0.777

表4 血清NT-proBNP、hs-cTn水平与心指数及3项指标联合预测NS患儿并发CD的ROC曲线分析结果

指标	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)	约登指数
血清NT-proBNP水平(ng/L)	0.814	0.734~0.894	<0.001	13 355	77.4	73.6	0.510
血清hs-cTn水平(ng/L)	0.858	0.784~0.931	<0.001	74	58.5	95.4	0.539
心指数[L/(min·m²)]	0.925	0.877~0.973	<0.001	2.74	84.9	93.1	0.780
上述3项指标联合	0.975	0.942~1.000	<0.001	—	81.1	96.6	0.777

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