Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock
Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock
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DOI：
10.1016/j.ijcard.2003.02.005
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发表时间：
2004-05-01
影响因子：
3.5
通讯作者：
Smith, PR
中科院分区：
文献类型：
--
作者：
Mehta, NJ;Khan, IA;Smith, PR
目的：本研究的目的是通过测定血清心肌肌钙蛋白I（cTnI）来确定感染性休克患者的心肌损伤，评价cTnI升高与心肌功能障碍之间的关系，并确定cTnI是否是这些患者预后的预测因子。方法：连续37例感染性休克患者纳入研究。在研究入组时以及24和48 h后测量血清cTnI。进行经胸超声心动图、心电图和定期生化和血流动力学评估。结果：16例（43%）患者血清cTnI升高。这些患者对正性肌力/血管加压药支持的需求较高（94% vs. 53%，p = 0.018），APACHE II评分较高（28 vs. 20，p = 0.004），超声心动图显示局部室壁运动异常的发生率较高（56% vs. 6%，p = 0.002）、射血分数较低（46% vs. 62%，p = 0.04）和死亡率较高（56% vs. 24%，p = 0.04）。多因素Logistic回归分析显示，血清cTnI和APACHE II评分是影响重症监护室死亡和住院时间的独立预测因素。血清cTnI、APACHE II评分、阴离子间隙和血清乳酸是需要正性肌力药物/血管加压药支持的独立预测因素。血清cTnI作为感染性休克死亡预测因子的受试者操作特征具有重要意义。血清cTnI水平升高与左室射血分数降低相关（P < 0.001）。结论：血清cTnI可作为判断感染性休克患者心肌损伤的指标。血清cTnI浓度与感染性休克心肌功能不全相关血清cTnI升高预示脓毒症严重程度增加和死亡率升高。有必要对感染性休克和cTnI水平升高的患者进行密切监测。(C)2003爱思唯尔爱尔兰有限公司保留所有权利。
Objective: The objectives of this study were to determine myocardial injury in patients with septic shock by measuring serum cardiac troponin I (cTnI), to evaluate relationship between elevated cTnI and myocardial dysfunction and to determine if cTnI is a predictor of outcome in these patients. Methods: Thirty-seven consecutive patients with septic shock were included in the study. Serum cTnI was measured at study entry and after 24 and 48 h. Transthoracic echocardiogram, electrocardiogram and regular biochemical and hemodynamic assessments were performed. Results: Sixteen (43%) patients had elevated serum cTnI. These patients had higher need for inotropic/ vasopressor support (94% vs. 53%, p = 0.018), higher APACHE II score (28 vs. 20, p = 0.004), higher incidence of regional wall motion abnormalities on echocardiography (56% vs. 6%, p = 0.002), lower ejection fraction (46% vs. 62%, p = 0.04) and higher mortality (56% vs. 24%, p = 0.04) compared to normal cTnI patients. By multiple logistic regression analysis, serum cTnI and APACHE II score were independent predictor of death and length of stay in intensive care unit. Serum cTnI, APACHE II score, anion gap and serum lactate were independent predictor of need for inotropic/vasopressor support. Receiver-operating characteristics of serum cTnI as a predictor of death in septic shock were significant. The elevated serum level of cTnI correlated with the lower left ventricular ejection fraction (p < 0.001). Conclusions: Myocardial injury can be determined in patients with septic shock by serum cTnI. Serum cTnI concentration correlates with myocardial dysfunction in septic shock. High serum cTnI predicts increased severity of sepsis and higher mortality. A close monitoring of patients with septic shock and elevated levels cTnI is warranted. (C) 2003 Elsevier Ireland Ltd. All rights reserved.