Circulating cardiac troponin I in trauma patients without cardiac contusion.
OBJECTIVE
To describe the evolution and the diagnostic value of cardiac troponin I (cTnI) and to relate its concentrations with the indicators of injury in trauma patients.


METHODS
Prospective, observational study of 17 young, previously healthy, mechanically-ventilated patients during the early post-traumatic period in the Surgical ICU of a University Hospital.


METHODS
Serial measurements of serum cTnI, total creatine kinase activity (CKtot) and its isoenzyme MB (CK-MB) (on admission, 12 h later, then daily for 7 days), clinical data and repeated electrocardiographic (ECG) and transesophageal echocardiographic (TEE) recordings.


RESULTS
Rhabdomyolysis was observed in all the patients with a significant relationship between CK-MB and CKtot. Despite the fact that no patient demonstrated ECG or TEE signs of myocardial contusion, elevated serum levels of cTnI were observed in six patients (35%) without obvious dilutional interference. As compared with the others, these patients exhibited a more frequent arterial hypotension (83% vs 18%, p = 0.035), required greater volume expansion on day 1 (22,000 vs 8,500 ml, p = 0.027) and usually demonstrated early (83% vs 9%, p = 0.005) and late (66% vs 9%, p = 0.028) multiple organ dysfunction syndrome.


CONCLUSIONS
Taking into account the high reported sensitivity and specificity of cTnI dosage, the present results suggest cTnI can play a role in the evaluation of indirect myocardial injury following traumatic shock.
Service d'Anesthésie-Réanimation, Central Hospitalier de Bicêtre, Le Kremlin Bicêtre, France. darkb@imaginet.fr
A R
AR
Edouard
J F
JF
Benoist
C
C
Cosson
O
O
Mimoz
A
A
Legrand
K
K
Samii
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D003422:Critical Care / Q000379:methods; D005260:Female; D006335:Heart Injuries / Q000097:blood* / Q000175:diagnosis* / Q000201:enzymology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000503:physiopathology; D009104:Multiple Trauma / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D009206:Myocardium / Q000737:chemistry*; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012206:Rhabdomyolysis / Q000097:blood / Q000175:diagnosis; D013997:Time Factors; D015599:Trauma Severity Indices; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D007527:Isoenzymes; D019210:Troponin I; D003402:Creatine Kinase