Dauhan Aileen C, Lubis Aridamuriany D, Mutiara Erna, Lubis Munar
Department of Child Health, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia.
Open Access Maced J Med Sci. 2019 Dec 13;7(23):4072-4077. doi: 10.3889/oamjms.2019.806. eCollection 2019 Dec 15.
Sepsis in children with cardiovascular involvement can increase mortality. Recently, many studies have been conducted to investigate troponin as an early marker of myocardial dysfunction, associated with pediatric sepsis score. Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score is recent scoring to assess organ dysfunction in sepsis children.
To determine the correlation between troponin T, troponin I with PELOD-2 score in sepsis as a predictive factor of mortality.
A prospective cohort study was conducted on sepsis children in PICU Haji Adam Malik General Hospital, Medan. Assessment of PELOD-2 score, serum troponin T, and troponin I levels performed on the first day and 48 hours after sepsis was diagnosed. Patients were observed until moved to the ward or died.
A group of 41 subjects were recruited in this study. Troponin T level at 24 hours did not correlate with PELOD-2 scores. Troponin T level at 48 hours was positively correlated with PELOD-2 score (r = 0.771, p < 0.001) and had a significant association with the mortality rate (p < 0.001). Troponin T at 48 hours could be used as a predictive factor of mortality (AUC 86.4%, p < 0.001) with a cut-off point of 40.3 ng/mL (76% sensitivity, 75% specificity, RR 2.48). Troponin I levels at 24 and 48 hours also had strong correlation with PELOD-2 score (r = 0.326, p = 0.037; r = 0.691, p < 0.001) and could be used as a predictor of mortality in pediatric patients with sepsis (AUC 74.8%, p 0.008; AUC 92.6%, p < 0.001). The cut-off point of troponin I at 24 hours was 0.075 ng/mL (68% sensitivity, 68.8% specificity, RR 1.84) and at 48 hours was 0.125 ng/mL (80% sensitivity, 81.3% specificity, RR 3.13).
Serum troponin T and troponin I levels at 48 hours have positive correlation with PELOD-2 score as a predictive factor of mortality in pediatric patients with sepsis.
伴有心血管受累的儿童脓毒症会增加死亡率。最近，已经开展了许多研究来调查肌钙蛋白作为心肌功能障碍的早期标志物，并与儿童脓毒症评分相关。儿童逻辑器官功能障碍2（PELOD-2）评分是最近用于评估脓毒症患儿器官功能障碍的评分方法。
确定脓毒症中肌钙蛋白T、肌钙蛋白I与PELOD-2评分之间的相关性，作为死亡率的预测因素。
在棉兰哈芝亚当马利克综合医院重症监护病房对脓毒症患儿进行了一项前瞻性队列研究。在脓毒症诊断后的第一天和48小时对PELOD-2评分、血清肌钙蛋白T和肌钙蛋白I水平进行评估。对患者进行观察，直至转至病房或死亡。
本研究招募了41名受试者。24小时时肌钙蛋白T水平与PELOD-2评分无相关性。48小时时肌钙蛋白T水平与PELOD-2评分呈正相关（r = 0.771，p < 0.001），且与死亡率有显著关联（p < 0.001）。48小时时的肌钙蛋白T可作为死亡率的预测因素（曲线下面积86.4%，p < 0.001），截断点为40.3 ng/mL（敏感性76%，特异性75%，相对危险度2.48）。24小时和48小时时的肌钙蛋白I水平也与PELOD-2评分有强相关性（r = 0.326，p = 0.037；r = 0.691，p < 0.001），可作为脓毒症患儿死亡率的预测指标（曲线下面积74.8%，p = 0.008；曲线下面积92.6%，p < 0.001）。24小时时肌钙蛋白I的截断点为0.075 ng/mL（敏感性68%，特异性68.8%，相对危险度1.84），48小时时为0.125 ng/mL（敏感性80%，特异性81.3%，相对危险度3.13）。
48小时时血清肌钙蛋白T和肌钙蛋白I水平与PELOD-2评分呈正相关，可作为脓毒症患儿死亡率的预测因素。
