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Balkan Med J. 2019 Nov 1. doi: 10.4274/balkanmedj.galenos.2019.2019.8.40. [Epub ahead of print]

Elevated plasma histone H4 levels are an important risk factor for the development of septic cardiomyopathy

Author information

1
Department of Critical Care Medicine, Beijing Electric Power Hospital, Beijing 100073, China
2
Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China
3
Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing 10006a8, China
4
Department of Critical Care Medicine, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, China
5
Department of Cardiac Function Tests, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, China

Abstract

Background:

Myocardial impairment is a major complication of sepsis and is an important prognostic predictor for septic patients. Therefore, early accurate diagnosis and timely management of septic cardiomyopathy is critical to achieve favorable outcomes.

Aims:

This study aimed to investigate the epidemiology and independent risk factors of septic cardiomyopathy.

Study Design:

Septic patients were divided into two groups: non-cardiomyopathy group (n = 45) and septic cardiomyopathy group (n = 48).

Methods:

Ninety-three septic patients in the intensive care unit (ICU) were recruited for this prospective study performed between May 2016 and June 2018. All patients received standardized treatments. Blood samples were collected and transthoracic echocardiography was performed within 24 hours of ICU admission. Septic patients with one ultrasound abnormality but no history of heart disease were diagnosed as having septic cardiomyopathy. Plasma histones, troponin (cTnI), and NT-proBNP were determined using ELISA. Sequential Organ Failure Assessment (SOFA) scores were evaluated, and vasopressor use and outcomes of ICU stay were analyzed. Spearman rank analysis was used to determine the correlation between plasma histone H4 and other parameters. Binary logistic regression and ROC curve analysis were used to determine the risk factors for septic cardiomyopathy.

Results:

Compared with the non-cardiomyopathy group, the septic cardiomyopathy group had significantly elevated plasma H4 and cTnI levels, a higher SOFA score, more frequent vasopressor use, and a higher mortality rate (P < 0.05). Plasma histone H4 levels were positively correlated with cTnI (r = 0.577, P = 0.000), NT-proBNP (r = 0.349, P = 0.001), and SOFA scores (r = 0.469, P = 0.000). Binary logistic regression and ROC curve analyses revealed that elevated plasma histone H4 levels and vasopressor use were important risk factors for septic cardiomyopathy (P < 0.05).

Conclusion:

Our study suggests that elevated plasma histone H4 levels could be used to predict septic cardiomyopathy in patients with sepsis.

KEYWORDS:

Histones; cardiac troponin; sepsis; septic cardiomyopathy; risk factors

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