Relationships of C-X-C motif chemokine ligand 9 and C-C motif chemokine ligand 20 in peripheral blood with myocardial injury indicators and prognosis in sepsis patients complicated by myocardial injury

Objective To investigate the relationships of C-X-C motif chemokine ligand 9 (CXCL9) and C-C motif chemokine ligand 20 (CCL20) in the peripheral blood with myocardial injury indicators as well as prognosis in patients with sepsis-induced myocardial injury (SIMD).

Methods A total of 116 SIMD patients (SIMD group) and 116 patients with sepsis alone (non-SIMD group) in the hospital from January 2022 to October 2024 were prospectively selected as the research objects. The SIMD patients were further divided into death group and survival group according to their 28-day prognostic outcomes. The levels of CXCL9 and CCL20 in the peripheral blood and myocardial injury indicatorscardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in these patients. Spearman correlation analysis was used to explore the correlations of CXCL9 and CCL20 in the peripheral blood with cTnI, CK-MB and NT-proBNP in SIMD patients, and the relationships of CXCL9 and CCL20 in the peripheral blood with the prognosis of SIMD patients were analyzed.

Results Compared with the non-SIMD group, the levels of CXCL9 and CCL20 in the peripheral blood, cTnI, CK-MB, and NT-proBNP in the SIMD group were significantly elevated (P < 0.05). Spearman correlation analysis showed that CXCL9 and CCL20 in the peripheral blood in SIMD patients were positively correlated with the levels of cTnI, CK-MB and NT-proBNP (r_s=0.798, 0.697, 0.629, 0.763, 0.631, 0.613, all P < 0.001). Among the 116 SIMD patients, the 28-day mortality rate was 43.97% (51/116). Compared with the survival group, the death group had significantly higher scores on the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Sequential Organ Failure Assessment (SOFA), as well as significantly elevated levels of cTnI, CK-MB, NT-proBNP, CXCL9 and CCL20 (P < 0.001). Logistic regression analysis revealed that high APACHE Ⅱ score, high SOFA score, high cTnI level, high NT-proBNP level, high CXCL9 level, and high CCL20 level were independent risk factors for death in SIMD patients (P < 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve (AUC) for the combined prediction of death in SIMD patients by cTnI, NT-proBNP, CXCL9 and CCL20 was 0.953, which was greater than 0.750, 0.734, 0.813 and 0.816 for the individual prediction by cTnI, NT-proBNP, CXCL9 and CCL20 (Z=4.584, 4.832, 3.995 and 4.107, all P < 0.001). After 1, 000-time Bootstrap self-sampling internal validation, the concordance index for the combined prediction by the four indicators was 0.953 (95%CI, 0.946 to 0.959).

Conclusion Elevated levels of CXCL9 and CCL20 in the peripheral blood are associated with aggravated myocardial injury and poor prognosis in SIMD patients, and the combined prediction of prognosis by two markers has higher efficacy.