Santiaguel Joel M, Zamora Mithi Kalayaan S, Pagar Norman D
Division of Pulmonary Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila.
Department of Medicine, Quirino Memorial Medical Center.
Acta Med Philipp. 2023 Nov 24;57(11):66-71. doi: 10.47895/amp.vi0.6376. eCollection 2023.
The study aimed to investigate the relationship between cardiac Troponin I (cTnI) level and prognosis among mechanically ventilated patients in terms of mortality, prolonged mechanical ventilation, and tracheostomy rate.
This is a prospective cohort study conducted at Quirino Memorial Medical Center, a tertiary government hospital, over a period of ten (10) months. Seventy-six (76) mechanically ventilated adult patients admitted at the medical intensive care unit, surgical intensive care unit, medical wards, and centers for neurologic sciences were included in the study. Quantitative cardiac Troponin I (cTnI) marker was measured and correlated to prognostic outcomes: a) prolonged ventilation (requiring more than 21 days), b) tracheostomy rate, and c) mortality rate. Data were analyzed using SPSS 16.0 and logistics regression with 95% confidence interval.
Results showed that among 76 patients, 15 patients have low cTnI levels, 11 patients have normal levels and 50 patients have elevated levels. Among patients with low cTnI levels (<0.020 ng/mL), 13 (86.7%) were extubated, 1 (6.7%) preceded tracheostomy and 1 (6.7%) expired. Those with normal range cTnI levels (0.020 - 0.060 ng/ mL), 10 (90.9%) were extubated, none (0%) preceded tracheostomy and 1 (9.1%) expired. Those with elevated cTnI levels (>0.060 ng/mL), 7 (14.0%) were extubated, 7 (14.0%) preceded tracheostomy and 36 (72.0%) expired.
Analysis of the results showed a significant correlation of cTnI elevation with prognostic outcome proven by the p-value of < 0.0001. The risk of mortality among subjects with above normal cTnI levels were nine times (9x) higher compared to subjects with normal or low cTnI levels. Duration of intubation among patients with low normal and high cTnI levels did not differ significantly. Tracheostomy rate in the study was inconclusive.
本研究旨在探讨机械通气患者的心肌肌钙蛋白I（cTnI）水平与死亡率、机械通气时间延长及气管切开率等预后指标之间的关系。
这是一项在奎里诺纪念医疗中心（一家三级政府医院）进行的前瞻性队列研究，为期十（10）个月。纳入了76例入住医疗重症监护病房、外科重症监护病房、内科病房和神经科学中心的机械通气成年患者。检测定量心肌肌钙蛋白I（cTnI）标志物，并将其与以下预后结果相关联：a）通气时间延长（超过21天），b）气管切开率，c）死亡率。使用SPSS 16.0进行数据分析，并采用95%置信区间的逻辑回归分析。
结果显示，76例患者中，15例cTnI水平低，11例水平正常，50例水平升高。在cTnI水平低（<0.020 ng/mL）的患者中，13例（86.7%）拔管，1例（6.7%）接受气管切开，1例（6.7%）死亡。cTnI水平在正常范围（0.020 - 0.060 ng/mL）的患者中，10例（90.9%）拔管，无（0%）接受气管切开，1例（9.1%）死亡。cTnI水平升高（>0.060 ng/mL）的患者中，7例（14.0%）拔管，7例（14.0%）接受气管切开，以及36例（72.0%）死亡。
结果分析显示，cTnI升高与预后结果存在显著相关性，p值<0.0001证明了这一点。cTnI水平高于正常的受试者的死亡风险比cTnI水平正常或低的受试者高九倍（9倍）。cTnI水平低、正常和高的患者的插管时间没有显著差异。本研究中的气管切开率尚无定论。
