Serum level of cardiac troponin I in pediatric patients with sepsis or septic shock.
OBJECTIVE
To evaluate serum level of contractile protein troponin I (cTnI) within the 24 hrs of sepsis and septic shock diagnosis in children and to correlate with the outcome (discharge from hospital or death).


METHODS
Prospective, observational study.


METHODS
Pediatric Intensive Care Unit, at Hospital Infantil Nossa Senhora da Glória, Vitória, ES, Brazil.


METHODS
Two hundred eighteen consecutive admissions of septic patients.


METHODS
None.


RESULTS
Measurement of serum cTnI (IMMULITE cTnI assay, Diagnostic Product Corporation, Los Angeles, CA) and creatine kinase MB isoenzyme and electrocardiographic tracings were performed within 24 hrs of sepsis or septic shock diagnosis. The pediatric index of mortality, pediatric index of mortality-2 was calculated for each patient. Primary diseases most frequently associated were pneumonia (42%) and meningitis (18%). The overall mortality was 12% (27 cases), 2.7% in the sepsis group, and 33% in the septic shock group. Both Pediatric Index of Mortality and Pediatric Index of Mortality-2 reached good discrimination. Electrocardiographic abnormalities were infrequent (9.2%). Abnormal serum levels of cTnI occurred in ten (4.5%) patients, significantly more frequent in the septic shock group than in sepsis group (13% vs. 0.7%, respectively; p = 0.000). Although frequency of elevated serum cTnI was significantly higher in nonsurvivors than in survivors (5 of 27 vs. 5 of 191, respectively; p = 0.003), this frequency not showed significant relationship with electrocardiogram alteration, creatine kinase MB isoenzyme levels, etiology of sepsis, or length of hospital days. In addition, a logistic regression analysis, taking in account age, gender, length of hospital days, sepsis definition, presence of meningitis, creatine kinase MB isoenzyme, and cTnI serum levels, demonstrated that severity of septic disease was the only variable significantly associated with the death.


CONCLUSIONS
Evaluation of serum levels of cTnI within the first 24 hrs of diagnosis of sepsis or septic shock in children was not better than creatine kinase MB isoenzyme or clinical evaluation, to predict the outcome (death or discharge from hospital) of septic process.
Department of Pediatric, Nossa Senhora da Glória Children's Hospital, Vitória, ES, Brazil. normatroponina@terra.com.br
Norma Suely
NS
Oliveira
Valmin Ramos
VR
Silva
Jane Sant' Ana
JS
Castelo
Jorge
J
Elias-Neto
Fausto Edmundo Lima
FE
Pereira
Werther Brunow
WB
Carvalho
D000890:Anti-Infective Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D052279:Creatine Kinase, MB Form / Q000097:blood; D004280:Dobutamine / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D019210:Troponin I / Q000097:blood*
D000890:Anti-Infective Agents; D015415:Biomarkers; D002316:Cardiotonic Agents; D019210:Troponin I; D004280:Dobutamine; D052279:Creatine Kinase, MB Form