تأثير تعفن الدم البكتيري على بعض المؤشرات الكيميائية الحيوية والمناعية في مرضى فشل القلب في محافظة كربلاء

Rp-Effect of Bacterial Sepsis on some Biochemical and Immunological Markers in Patients with Heart Failure in Karbala Province.pdf

Cardiovascular diseases are leading causes of morbidity and mortality, with myocardial ischemia and heart failure representing two major yet distinct entities. Myocardial ischemia denotes insufficient oxygen supply to the myocardium due to coronary obstruction, whereas heart failure reflects the inability of the heart to meet systemic circulatory demands. Despite their differences, ischemia is a principal cause of heart failure, and both conditions frequently coexist, In the setting of sepsis, systemic inflammation and circulatory dysregulation exacerbate ischemia and contribute to sepsis-induced cardiomyopathy, thereby complicating diagnosis, management, and prognosis.
The present study was designed to determine the most prevalent bacterial species that cause sepsis in heart failure patients, investigate their association with heart failure risk factors, and identify their pattern of antibiotic susceptibility and identify different parameters levels that effected by bacterial infection in heart failure patients. One hundred patients were divided into four groups: Twenty-five patients with heart failure and sepsis (G1), twenty-five patients with heart failure alone (G2) ,twenty-five patients with sepsis alone (G3) and twenty-five for healthy individual (G4). They were collected directly from the coronary care unit at the Heart Center in Imam Hussein Medical City in Karbala during the period from January 2024 to August 2024. Ten ml of venous blood sample were taken from heart failure patients after admission to the Coronary Care Unit (CCU). There is an important procedure of blood culturing that should be applied, Immunological tests were performed such as, Troponin, N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP), C-type Natriuretic Peptide (CNP), Ischemia-Modified albumin (IMA), soluble CD40 Ligand (sCD40L), C-reactive protein (CRP) and Procalcitonin (PCT). General parameters such as Age (age groups included 20-39, 40-59, 60-79, 80-99 year) and Sex (male 53, female 47). Hematological Parameters (CBC) such as White blood cell (WBC) Lymphocyte (LYM) and Neutrophil (NEU), Red blood cell (RBC), Hemoglobin (HGB), Platelet (PLT) and Hematocrit (HCT), Bacteriological tests (Identification of Bacteria and Antibiotics Susceptibility Tests).
The results of current study showed that there were no significant differences (P ≥ 0.05) between female and male in the study groups (no heart failure with infection G3, heart failure without infection G2 and Heart failure with infection G1) compared with healthy group G4.
The results showed no significant difference (P ≥ 0.05) between Gram-positive and Gram-negative bacteria in both the groups of infection with heart failure and without heart failure. The most common bacterial species in the heart failure group was Staphylococcus hominis which accounted for 10% isolates followed by Staphylococcus haemolyticus and Acinetobacter baumannii which accounted for 8% isolates for each of them. In the group of infection without heart failure (G3), Klebsiella pneumoniae bacteria was the most common which accounted for 16% isolates, followed by Pseudomonas aeruginosa and Coagulase negative Staphylococci which accounted for 8% isolates for each of them. All isolated species were found to be resistant to Ciprofloxacin (80%) in both groups and all isolated species were sensitive to Pefloxacin, Colistin, Ampicillin, Vancomycin, Linezolid, Streptomycin, Ceftazidime/Avibactam and Ceftolozane/Tazobactam in heart failure with infection group (G1).
The serological results demonstrated that there was increased significant (P ≤ 0.0001) difference between the two groups with heart failure compared to the two groups without heart failure for Troponin. Also, the results showed that there was increased significant (P ≤ 0.0001) difference for N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) , C-type natriuretic peptide (CNP) , Ischemia-modified albumin (IMA), Soluble CD40 ligand (sCD40L) , C-Reactive Protein (CRP) and Procalcitonin (PCT) in the serum levels of study groups compare to the healthy group.
The results of Roc analysis suggested that Troponin was the most reliable biomarker for diagnosing heart failure, followed by IMA, NT-proBNP and sCD40L. Other biomarkers have varying degrees of effectiveness, with some showing fair performance.
The hematological results showed there was increased significant in the count of total white blood cell (WBC) and neutrophils in the groups of bacterial infection with and without heart failure compared to the heart failure alone group and healthy group. As current study showed a significant decrease (P ≤ 0.0001) in the RBCs, HGB, HCT, PLT and lymphocyte count in patients compare with the healthy group.
The study concluded that the most prevalent species of bacteria were Staphylococcus hominis in the heart failure group and Klebsiella pneumoniae in the group of bacterial infection without heart failure. In addition, the isolated bacteria were highly resistant to Ciprofloxacin in both groups and highly sensitive to some antibiotics. Also, the results demonstrated that there were highly significant differences (P ≤ 0.0001) between the groups with heart failure and bacterial infection compared to the healthy groups in Troponin , NT-pro BNP , CNP, IMA, sCD40L, CRP and PCT.