Metabolic Derangements and the Risk of Septic Cardiomyopathy: A Predictive Analysis

Objective Sepsis‐induced cardiomyopathy (SIC) is a severe complication associated with increased mortality. This study aimed to investigate the association between routinely available laboratory parameters, particularly metabolic markers, and the development of SIC in patients with sepsis, and to identify potential independent risk factors for this condition. Methods This retrospective cohort analysis included 497 adult patients diagnosed with sepsis or septic shock at the ICU of a tertiary hospital from June 2021 to September 2023. Patients were categorized into the SIC group ( n = 201) or the non‐SIC group ( n = 296) based on a standardized definition: new‐onset left ventricular ejection fraction (LVEF < 50%) within 48 h of admission, with normalization confirmed by follow‐up transthoracic echocardiography (TTE). To ensure diagnostic accuracy, patients who died or were discharged before the follow‐up TTE could be performed were excluded from the analysis. Demographic, clinical, and laboratory parameters were collected. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cut‐off values based on the maximum Youden index. Multivariable binary logistic regression with backward elimination was performed to identify independent risk factors for the occurrence of SIC, as the primary endpoint was a categorical binary outcome. Survival analysis was conducted using the Kaplan–Meier method and log‐rank test. Results The incidence of SIC was 40.4% (201/497). Mortality was significantly higher in the SIC group compared to the non‐SIC group (33.8% vs. 13.5%, p < 0.001). Patients in the SIC group exhibited significantly elevated levels of blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), procalcitonin (PCT), and interleukin‐6 (IL‐6), while total cholesterol (TC) and platelet count (PLT) were lower (all p < 0.05). ROC analysis identified optimal cut‐off values for multiple parameters, including BUN ≥ 8.35 mmol/L (AUC = 0.79), Cr ≥ 84.5 μmol/L (AUC = 0.86), and NT‐proBNP ≥ 1886 pg/mL (AUC = 0.96). Multivariable logistic regression revealed that elevated BUN (analyzed as a continuous variable) was an independent risk factor for SIC (OR = 1.86, 95% CI: 1.01–3.45, p = 0.049). Conclusion Elevated BUN (≥ 8.35 mmol/L) is an independent metabolic risk factor for SIC. The identified “inflammation–metabolism–myocardial injury” triad provides a clinically accessible framework for early risk stratification of SIC in septic patients.