ObjectiveTo investigate the correlation on serum levels of pyruvate dehydrogenase kinase 4 (PDK4), NOD like receptor protein 3 (NLRP3), phosphatase and tensin homolog deleted on chromosome ten (PTEN) with myocardial injury indicators and prognosis in sepsis patients.MethodsFrom September 2021 to September 2023, Collection of 355 patients with first diagnosis of sepsis admitted to our hospital were gathered and separated into sepsis induced myocardial injury (SIMI) group (225 cases) and sepsis alone group (130 cases) based on whether they had myocardial injury, and were divided into the death group (56 patients) and the survival group (169 patients) according to the prognostic survival of the patients after 28 d of treatment. Real-time fluorescence quantitative PCR (qRT-PCR) was applied to detect serum levels of PDK4, NLRP3, and PTEN. Fully automated biochemical analyzer was applied to detect the levels of creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), myoglobin (Mb), and heart type fatty acid binding protein (H-FABP). Pearson correlation coefficient method was applied to analyze the relationship between serum PDK4, NLRP3, PTEN and myocardial injury indicators in SIMI patients. Cox regression was applied to analyze the factors influencing the prognosis of SIMI patients.ResultsThe levels of serum PDK4, NLRP3, PTEN, CK-MB, cTnI, Mb, and H-FABP in the SIMI group were obviously higher than those in the sepsis alone group (P<0.05). The levels of serum PDK4, NLRP3, PTEN in sepsis patients were positively correlated with myocardial injury indicators CK-MB, cTnI, Mb, and H-FABP (P<0.05). The APACHE Ⅱ score, SOFA score, cTnI, and serum PDK4, NLRP3, and PTEN levels in the prognostic death group were higher than those in the survival group (P<0.05). APACHE Ⅱ score, SOFA score, cTnI, PDK4, NLRP3, and PTEN were independent risk factors affecting the prognosis of SIMI patients (P<0.05).ConclusionSerum PDK4, NLRP3, and PTEN are all highly expressed in SIMI patients, and they are independent risk factors affecting the prognosis of SIMI patients.