Cardiac troponin-I as a marker of myocardial dysfunction in children with septic shock.

Abstract

Cardiac depression is well known in severe sepsis and septic shock. Our aim was to investigate the incidence of myocardial ischaemia as shown by cardiac troponin I (cTnI) levels in patients with septic shock and to evaluate the correlation with myocardial dysfunction measured by echocardiography. The study was performed in the paediatric intensive care unit in Dicle University Hospital, Turkey, between January 2001 and December 2002. Patients in septic shock, with a mean age of 6.4 +/- 2.8 months, were simultaneously submitted to a two-dimensional echocardiogram and biochemical investigation on admission. The mean serum cTnI level of the patients was 3.1 +/- 2.6 ng/ml (0.01-9.80 ng/ml) and the mean LVEF value was calculated as 48% +/- 11%. 21 patients (75%) had a cTnI level >/=0.6 ng/ml, and 15 patients (54%) had a LVEF <0.5. For cTnI levels >/=0.6 ng/ml, sensitivity and specificity were 93.3% and 46.2%, and positive and negative predictive values were 66.7% and 85.7% respectively. For cTnI values >/=2.0 ng/ml, sensitivity and specificity were 86.7% and 76.9%, and positive and negative predictive values were 81.3% and 83.3%, respectively. There was a statistically significant relationship between LV dysfunction and cTnI positivity (r2 = 0.316, p = 0.002). No significant difference was found for the cTnI levels >/=0.6 ng/ml between non-survivors and survivors (p >0.05). Myocardial ischaemia and cell injury seem to be common in patients with septic shock and correlate with left ventricular dysfunction. Measurement of cTnI may be an easy and practical tool for monitoring cardiac damage in critically ill septic patients.