Comparison of Troponin I levels versus myocardial dysfunction on prognosis in sepsis
| Autor: | Valerio Stefanone, Stefano Calcagno, Riccardo Pini, Federico D’Argenzio, Vittorio Palmieri, Michele Montuori, Francesca Innocenti, Anna De Paris, Marco Cigana, Elisa Capretti, Irene Tassinari |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Ventricular Dysfunction Right Context (language use) 030204 cardiovascular system & hematology Sepsis Ventricular Dysfunction Left 03 medical and health sciences 0302 clinical medicine Internal medicine Troponin I Internal Medicine medicine Humans Prospective Studies 030212 general & internal medicine Prospective cohort study Survival analysis biology business.industry Mortality rate Prognosis medicine.disease Troponin Emergency Medicine biology.protein Cardiology SOFA score Sepsis-associated myocardial dysfunction Cardiomyopathies business |
| Zdroj: | Internal and Emergency Medicine. 17:223-231 |
| ISSN: | 1970-9366 1828-0447 |
| DOI: | 10.1007/s11739-021-02701-3 |
| Popis: | In the context of sepsis, we tested the relationship between echocardiographic findings and Troponin, and their impact on prognosis. In this prospective study, we enrolled 325 septic patients (41% with shock), not mechanically ventilated, between October, 2012 and June, 2019 among those admitted to our High-Dependency Unit. By echocardiography within 24 h from the admission, sepsis-induced myocardial dysfunction (SIMD) was defined as left ventricular (LV) systolic dysfunction (speckle-tracking-based global longitudinal peak systolic strain, GLS, - 14%) and/or right ventricular (RV) systolic dysfunction (Tricuspid Annular Plane Systolic Excursion, TAPSE 16 mm). Troponin I levels were measured upon admission (T0) and after 24 h (T1); it was considered normal if 0.1 ng/mL. Mortality was assessed at day-7 and day-28 end-points. One-hundred and forty-two patients had normal Troponin level at T0 and T1 (G1), 69 had abnormal levels at T0 or T1 (G2) and 114 showed abnormal Troponin levels at both T0 and T1 (G3). Compared to G1, patients in G3 had worse LV and RV systolic function (GLS - 11.6 ± 3.4% vs - 14.0 ± 3.5%, p 0.001; TAPSE 18 ± 0.5 vs 19 ± 0.5 mm, p = 0.047) and greater day-28 (34% vs 20%, p = 0.015) mortality. In a Cox survival analysis including age, Troponin and SOFA score, mortality was predicted by the presence of SIMD (RR 3.24, 95% CI 1.72-6.11, p 0.001) with no contribution of abnormal Troponin level. While abnormal Troponin levels were associated with SIMD diagnosed by echocardiography, only the presence of SIMD predicted the short- and medium-term mortality rate, without an independent contribution of increased Troponin levels. |
| Databáze: | OpenAIRE |
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