Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan.
Mediators Inflamm. 2022 May 27;2022:5331474. doi: 10.1155/2022/5331474. eCollection 2022.
The diagnostic value and optimal cutoff level of cardiac troponin I in patients with sepsis have not been studied. In this single hospital retrospective study, we assessed the optimal cutoff value of troponin I for diagnosing non-ST-segment elevation myocardial infarction (NSTEMI) with type 1 myocardial infarction (MI) in patients with sepsis who had undergone a percutaneous coronary intervention from 2009 to 2019. In total, 5,341 patients (excluding patients with chronic kidney disease) were included, of whom 277 had sepsis or septic shock. Of the 123 patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and sepsis, 77 (62.6%) were diagnosed with NSTEMI with type 1 MI. The receiver-operating characteristic curve showed an area under the curve (AUC) of 0.705 for diagnosis of NSTEMI with type 1 MI with a troponin I cutoff of >300 ng/L (sensitivity: 68.4%, specificity: 70.2%, Youden index: 0.386). Multiple linear regression showed no significant predictors of NSTEMI with type 1 MI. Troponin level and the Global Registry of Acute Coronary Events (GRACE) scores were correlated ( = 0.0625, = 0.032) and showed comparable predictive value for 6-month mortality (AUC: 0.637 and 0.611, respectively, = 0.7651). The optimal troponin I cutoff to effectively diagnose NSTEMI with type 1 MI in patients with sepsis was 300 ng/L.
在脓毒症患者中，心肌肌钙蛋白 I 的诊断价值和最佳截断值尚未得到研究。在这项单中心回顾性研究中，我们评估了肌钙蛋白 I 在 2009 年至 2019 年接受经皮冠状动脉介入治疗的脓毒症患者中诊断 1 型心肌梗死（MI）伴非 ST 段抬高型心肌梗死（NSTEMI）的最佳截断值。共纳入 5341 例（不包括慢性肾脏病患者），其中 277 例患有脓毒症或脓毒性休克。在 123 例非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）合并脓毒症患者中，77 例（62.6%）被诊断为 1 型 MI 伴 NSTEMI。受试者工作特征曲线显示，肌钙蛋白 I 截断值>300ng/L 时诊断 1 型 MI 伴 NSTEMI 的曲线下面积（AUC）为 0.705（敏感性：68.4%，特异性：70.2%，约登指数：0.386）。多线性回归显示，1 型 MI 伴 NSTEMI 无显著预测因子。肌钙蛋白水平和全球急性冠状动脉事件登记处（GRACE）评分相关（ = 0.0625， = 0.032），且对 6 个月死亡率有相似的预测价值（AUC：0.637 和 0.611，分别， = 0.7651）。脓毒症患者中，有效诊断 1 型 MI 伴 NSTEMI 的最佳肌钙蛋白 I 截断值为 300ng/L。
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