Leite Heitor P, Medina Rodrigo, Junior Emilio L, Konstantyner Tulio
Discipline of Nutrition and Metabolism, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil.
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
J Pediatr Intensive Care. 2021 Jun 22;12(3):203-209. doi: 10.1055/s-0041-1731432. eCollection 2023 Sep.
Cardiac troponin-I (cTnI) is a biomarker of myocardial injury with implications for clinical outcomes. May other contributing factors that could affect outcomes have not been uniformly considered in pediatric studies. We hypothesized that there is an association between admission serum cTnI and outcomes in critically ill children taking into account the magnitude of the acute systemic inflammatory response syndrome (SIRS), serum lactate concentrations, and nutritional status. Second, we tested for potential factors associated with elevated serum cTnI. This was a prospective cohort study in 104 children (median age: 21.3 months) consecutively admitted to a pediatric intensive care unit (PICU) of a teaching hospital with SIRS and without previous chronic diseases. Primary outcome variables were PICU-free days, ventilator-free days, and 30-day mortality. Exposure variables were serum cTnI concentration on admission, revised pediatric index of mortality (PIM2), pediatric logistic organ dysfunction (PELOD-2), hypotensive shock, C-reactive protein, procalcitonin, and serum lactate on admission, and malnutrition. Elevated cTnI (>0.01 μg/L) was observed in 24% of patients, which was associated with the reduction of ventilator-free days (β coefficient = - 4.97; 95% confidence interval [CI]: -8.03; -1.91) and PICU-free days (β coefficient = - 5.76; 95% CI: -8.97; -2.55). All patients who died had elevated serum cTnI. The increase of 0.1 μg/L in cTnI concentration resulted in an elevation of 2 points in the oxygenation index (β coefficient = 2.0; 95% CI: 1.22; 2.78, < 0.001). The PIM2 score, hypotensive shock in the first 24 hours, and serum lactate were independently associated with elevated cTnI on admission. We conclude that elevated serum cTnI on admission is independently associated with adverse outcomes in children with SIRS and without associated chronic diseases.
心肌肌钙蛋白I（cTnI）是一种心肌损伤生物标志物，对临床结局有影响。在儿科研究中，可能影响结局的其他因素尚未得到统一考虑。我们假设，在考虑急性全身炎症反应综合征（SIRS）的严重程度、血清乳酸浓度和营养状况的情况下，危重症儿童入院时血清cTnI与结局之间存在关联。其次，我们检测了与血清cTnI升高相关的潜在因素。这是一项前瞻性队列研究，对104名儿童（中位年龄：21.3个月）进行了连续观察，这些儿童因SIRS连续入住一家教学医院的儿科重症监护病房（PICU），且既往无慢性疾病。主要结局变量为无PICU天数、无呼吸机天数和30天死亡率。暴露变量为入院时血清cTnI浓度、修订后的儿科死亡率指数（PIM2）、儿科逻辑器官功能障碍（PELOD-2）、低血压休克、C反应蛋白、降钙素原、入院时血清乳酸以及营养不良。24%的患者观察到cTnI升高（>0.01μg/L），这与无呼吸机天数减少（β系数=-4.97；95%置信区间[CI]：-8.03；-1.91）和无PICU天数减少（β系数=-5.76；95%CI：-8.97；-2.55）相关。所有死亡患者的血清cTnI均升高。cTnI浓度每增加0.1μg/L，氧合指数升高2分（β系数=2.0；95%CI：1.22；2.78，P<0.001）。PIM2评分、最初24小时内的低血压休克和血清乳酸与入院时cTnI升高独立相关。我们得出结论，入院时血清cTnI升高与无相关慢性疾病的SIRS儿童的不良结局独立相关。
