Cargando…

Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock

(1) Background: Myocardial dysfunction in patients with sepsis is not an uncommon phenomenon, yet reported results are conflicting and there is no objective definition. Measurement of troponin may reflect the state of the heart and may correlate with echocardiographically derived data. This study ai...

Descripción completa

Detalles Bibliográficos
Autores principales: Kim, June-Sung, Kim, Muyeol, Kim, Youn-Jung, Ryoo, Seung Mok, Sohn, Chang Hwan, Ahn, Shin, Kim, Won Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406324/
https://www.ncbi.nlm.nih.gov/pubmed/30759844
http://dx.doi.org/10.3390/jcm8020239
_version_ 1783401275018182656
author Kim, June-Sung
Kim, Muyeol
Kim, Youn-Jung
Ryoo, Seung Mok
Sohn, Chang Hwan
Ahn, Shin
Kim, Won Young
author_facet Kim, June-Sung
Kim, Muyeol
Kim, Youn-Jung
Ryoo, Seung Mok
Sohn, Chang Hwan
Ahn, Shin
Kim, Won Young
author_sort Kim, June-Sung
collection PubMed
description (1) Background: Myocardial dysfunction in patients with sepsis is not an uncommon phenomenon, yet reported results are conflicting and there is no objective definition. Measurement of troponin may reflect the state of the heart and may correlate with echocardiographically derived data. This study aimed to evaluate the role of admission and peak troponin-I testing for the identification of sepsis-induced myocardial dysfunction (SIMD) by transthoracic echocardiography (TTE). (2) Methods: This was a retrospective cohort study using a prospective registry of septic shock at an Emergency Department from January 2011 and April 2017. All 1,776 consecutive adult septic shock patients treated with protocol-driven resuscitation bundle therapy and tested troponin-I were enrolled. SIMD was defined as left ventricular (LV) systolic/diastolic dysfunction, right ventricular (RV) diastolic dysfunction, or global/regional wall motion abnormalities (WMA). (3) Results: Of 660 (38.4%) septic shock patients with an elevated hs-TnI (≥0.04 ng/mL) at admission, 397 patients underwent TTE and 258 cases (65%) showed SIMD (LV systolic dysfunction (n = 163, 63.2%), LV diastolic dysfunction (n = 104, 40.3%), RV dysfunction (n = 97, 37.6%), and WMA (n = 186, 72.1%)). In multivariate analysis, peak hs-TnI (odds ratio 1.03, 95% confidence interval 1.01–1.06, p = 0.008) and ST-T wave changes in the electrocardiogram (odds ratio 1.82, 95% confidence interval 1.04–2.39, p = 0.013) were associated with SIMD, in contrast to hs-TnI level at admission. The area under the curve of peak hs-TnI was 0.668. When the peak hs-TnI cutoff value was 0.634 ng/mL, the sensitivity and specificity for SIMD were 58.6% and 59.1%, respectively. 4) Conclusions: About two-thirds of patients with an elevated hs-TnI level have various cardiac dysfunctions in terms of TTE. Rather than the initial level, the peak hs-TnI and ST-T change may be considered as a risk factor of SIMD.
format Online
Article
Text
id pubmed-6406324
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-64063242019-03-22 Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock Kim, June-Sung Kim, Muyeol Kim, Youn-Jung Ryoo, Seung Mok Sohn, Chang Hwan Ahn, Shin Kim, Won Young J Clin Med Article (1) Background: Myocardial dysfunction in patients with sepsis is not an uncommon phenomenon, yet reported results are conflicting and there is no objective definition. Measurement of troponin may reflect the state of the heart and may correlate with echocardiographically derived data. This study aimed to evaluate the role of admission and peak troponin-I testing for the identification of sepsis-induced myocardial dysfunction (SIMD) by transthoracic echocardiography (TTE). (2) Methods: This was a retrospective cohort study using a prospective registry of septic shock at an Emergency Department from January 2011 and April 2017. All 1,776 consecutive adult septic shock patients treated with protocol-driven resuscitation bundle therapy and tested troponin-I were enrolled. SIMD was defined as left ventricular (LV) systolic/diastolic dysfunction, right ventricular (RV) diastolic dysfunction, or global/regional wall motion abnormalities (WMA). (3) Results: Of 660 (38.4%) septic shock patients with an elevated hs-TnI (≥0.04 ng/mL) at admission, 397 patients underwent TTE and 258 cases (65%) showed SIMD (LV systolic dysfunction (n = 163, 63.2%), LV diastolic dysfunction (n = 104, 40.3%), RV dysfunction (n = 97, 37.6%), and WMA (n = 186, 72.1%)). In multivariate analysis, peak hs-TnI (odds ratio 1.03, 95% confidence interval 1.01–1.06, p = 0.008) and ST-T wave changes in the electrocardiogram (odds ratio 1.82, 95% confidence interval 1.04–2.39, p = 0.013) were associated with SIMD, in contrast to hs-TnI level at admission. The area under the curve of peak hs-TnI was 0.668. When the peak hs-TnI cutoff value was 0.634 ng/mL, the sensitivity and specificity for SIMD were 58.6% and 59.1%, respectively. 4) Conclusions: About two-thirds of patients with an elevated hs-TnI level have various cardiac dysfunctions in terms of TTE. Rather than the initial level, the peak hs-TnI and ST-T change may be considered as a risk factor of SIMD. MDPI 2019-02-12 /pmc/articles/PMC6406324/ /pubmed/30759844 http://dx.doi.org/10.3390/jcm8020239 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kim, June-Sung
Kim, Muyeol
Kim, Youn-Jung
Ryoo, Seung Mok
Sohn, Chang Hwan
Ahn, Shin
Kim, Won Young
Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock
title Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock
title_full Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock
title_fullStr Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock
title_full_unstemmed Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock
title_short Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock
title_sort troponin testing for assessing sepsis-induced myocardial dysfunction in patients with septic shock
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406324/
https://www.ncbi.nlm.nih.gov/pubmed/30759844
http://dx.doi.org/10.3390/jcm8020239
work_keys_str_mv AT kimjunesung troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock
AT kimmuyeol troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock
AT kimyounjung troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock
AT ryooseungmok troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock
AT sohnchanghwan troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock
AT ahnshin troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock
AT kimwonyoung troponintestingforassessingsepsisinducedmyocardialdysfunctioninpatientswithsepticshock