Myocardial injury in infants ventilated on the paediatric intensive care unit: a case control study

Simon J Clark,Paul Newland,Kent Thorburn,Dorothea Sidaras,Stephen W Hancock,Michael Eisenhut

doi:10.1186/cc5040

Simon J Clark, Paul Newland + Show 4 more

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https://doi.org/10.1186/cc5040

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Journal: Critical Care	Publication Date: Jan 1, 2006
Citations: 28	License type: cc-by

Affiliation: Liverpool Community Health NHS Trust

Abstract

IntroductionCardiac troponin T (cTnT) has been used to assess prevalence of myocardial injury in critically ill children. The majority of studies investigated patients undergoing cardiac surgery. Myocardial injury has been associated with increased mortality. Our objectives were to investigate whether cTnT levels are elevated in infants without congenital heart disease admitted to the paediatric intensive care unit (PICU) and whether levels are associated with increased disease severity.MethodsWe measured cTnT in consecutive infants (<12 months old) without congenital heart disease admitted to the PICU and healthy infants. The Paediatric Index of Mortality (PIM) score was determined in patients on the PICU.ResultsWe recruited 107 infants: 47 infants admitted to the PICU and 60 healthy controls. Controls were, with a median (interquartile range (IQR)) age of 20 (12 to 34) weeks, significantly older than cases, with a median age of 6.5 (0.3 to 20.6) weeks. CTnT levels were, with a median (IQR) of 18 (10 to 60) pg/ml, significantly higher in admissions to the PICU than in controls, with a median level of 10 (10 to 10) pg/ml (95th centile of 20 pg/ml) (p < 0.001). There was a significant positive correlation (r = 0.41, p = 0.004) between PIM score and cTnT levels. Admissions under one month old had higher cTnT levels than older patients (p = 0.013) but the PIM score was not significantly different between them. When corrected for age and weight the correlation of PIM and cTnT was no longer significant.ConclusionInfants on the PICU in the neonatal period have higher cTnT levels compared to older infants despite not having more severe disease.

Highlights

Introduction Cardiac troponinT has been used to assess prevalence of myocardial injury in critically ill children
Our objectives were to investigate whether Cardiac troponin T (cTnT) levels are elevated in infants without congenital heart disease admitted to the paediatric intensive care unit (PICU) and whether levels are associated with increased disease severity
Infants on the PICU in the neonatal period have higher cTnT levels compared to older infants despite not having more severe disease

Summary

Introduction

Introduction Cardiac troponinT (cTnT) has been used to assess prevalence of myocardial injury in critically ill children. The third generation assays for cardiac troponin T (cTnT) are so sensitive and specific that a concept of minimal myocardial damage has arisen [1] These marginal elevations of cTnT are associated with increased hospital morbidity and mortality in adult patients following admission [3,4]. Elevated cardiac troponin levels have been detected in children critically ill with congenital heart disease before and after cardiac surgery [5,7]. In patients without congenital heart disease raised cardiac troponin levels have been found in paediatric intensive care admissions with severe respiratory syncytial virus infection [8] and with meningococcal and other forms of septicemia [9,10,11,12]. In meningococcal septicemia cardiac troponin levels have been associated with increased disease severity and cardiac dysfunction [9]

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