高敏肌钙蛋白I在感染性休克患者中的预后价值：一项前瞻性观察研究
Prognostic Value of High-sensitivity Troponin I in Patients with Septic Shock: A Prospective Observational Study.
作者信息
Jendoubi Ali, Jerbi Salma, Maamar Elaa, Abbess Ahmed, Samoud Zied, Kanzari Lamia, Boutiba Ilhem, Ghedira Salma, Houissa Mohamed
机构信息
Department of Anaesthesia and Intensive Care, Charles Nicolle Hospital of Tunis, Tunisia.
Laboratory of Microbiology, Charles Nicolle Hospital of Tunis, Tunisia.
出版信息
Indian J Crit Care Med. 2019 Jul;23(7):320-325. doi: 10.5005/jp-journals-10071-23206.
BACKGROUND
Myocardial dysfunction is one of the mechanisms involved in the pathophysiology of septic shock. The role of troponin as a surrogate of myocardial injury in septic shock is still debated. The aim of this study was to assess the prognostic value of high-sensitivity cardiac troponin I (hs-cTnI) assay in predicting 28-day mortality in patients with septic shock.
MATERIALS AND METHODS
Prospective study including 75 patients with septic shock admitted to a medico-surgical ICU from January to December 2017. Patients under the age of 18 years, known pregnancy and patients in post-cardiac arrest were excluded. Clinical and demographic data including age, gender, comorbidities, SAPS II and SOFA scores were collected. Hs-cTnI was measured soon after admission and 12, 24, 48 and 72 after. Receiver operating characteristic (ROC) analysis was performed to identify the most useful troponin I cut-off level for the prediction of 28-day mortality. A <0.05 was considered significant.
RESULTS
Seventy-five (M/F = 53/22) patients with septic shock were included in the study. The median SOFA and SAPS II scores were 10 and 42, respectively. The median duration of mechanical ventilation was 8 days and the median length of ICU stay was 11 days. The 28-day mortality was 54.6%. We found a high prevalence (47%) of elevated hs-cTnI in patients with septic shock. Median hs-cTnI on admission in the whole group was 36 ng/L. The 28-day mortality was found to be related to age ( <0.001), SAPS II score ( = 0.001), mean arterial pressure ( = 0.038), lactate ( <0.001) and glomerular filtration rate ( <0.001).Hs-cTnI levels were significantly higher in non-survival group than survival one at all time points: H12 ( = 0.006), H24 ( = 0.003), H48 ( = 0.005) and H72 (p=0.001). In multivariate analysis, hs-cTnI at H72 was independently associated with 28-day mortality.
CONCLUSION
Hs-cTnI elevation at 72 hours was associated with 28-day mortality in septic shock patients.
HOW TO CITE THIS ARTICLE
Jendoubi A, Jerbi S, Maamar E, Abbess A, Samoud Z, Kanzari L, . Prognostic Value of High-Sensitivity Troponin I in Patients with Septic Shock: A Prospective Observational Study. Indian J Crit Care Med 2019;23(7):320-325.
背景
心肌功能障碍是脓毒性休克病理生理学的相关机制之一。肌钙蛋白作为脓毒性休克中心肌损伤替代指标的作用仍存在争议。本研究旨在评估高敏心肌肌钙蛋白I（hs-cTnI）检测对预测脓毒性休克患者28天死亡率的预后价值。
材料与方法
前瞻性研究，纳入2017年1月至12月入住一所内科-外科重症监护病房的75例脓毒性休克患者。排除18岁以下患者、已知妊娠患者和心脏骤停后患者。收集临床和人口统计学数据，包括年龄、性别、合并症、序贯器官衰竭评估（SOFA）Ⅱ评分和简化急性生理学评分（SAPS）Ⅱ评分。入院后不久以及入院后12、24、48和72小时检测hs-cTnI。进行受试者工作特征（ROC）分析，以确定预测28天死亡率最有用的肌钙蛋白I临界值。P<0.05被认为具有统计学意义。
结果
本研究纳入75例（男/女=53/22）脓毒性休克患者。SOFA评分中位数和SAPSⅡ评分中位数分别为10分和42分。机械通气的中位持续时间为8天，重症监护病房住院时间的中位数为11天。28天死亡率为54.6%。我们发现脓毒性休克患者中hs-cTnI升高的发生率较高（47%）。全组患者入院时hs-cTnI中位数为36 ng/L。发现28天死亡率与年龄（P<0.001）、SAPSⅡ评分（P=0.001）、平均动脉压（P=0.038）、乳酸（P<0.001）和肾小球滤过率（P<0.001）有关。在所有时间点，非存活组的hs-cTnI水平均显著高于存活组：H12（P=0.006）、H24（P=0.003）、H48（P=0.005）和H72（P=0.001）。在多变量分析中，H72时的hs-cTnI与28天死亡率独立相关。
结论
72小时时hs-cTnI升高与脓毒性休克患者的28天死亡率相关。
如何引用本文
Jendoubi A，Jerbi S，Maamar E，Abbess A，Samoud Z，Kanzari L，等。高敏肌钙蛋白I在脓毒性休克患者中的预后价值：一项前瞻性观察研究。《印度重症监护医学杂志》2019；23（7）：320 - 325。
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