title: High-sensitive cardiac Troponin T is superior to echocardiography in predicting 1-year mortality in patients with SIRS and shock in intensive care.
abstract: BACKGROUND
  Left ventricular (LV) dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock.
  
  
  METHODS
  A prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP), high-sensitive troponin T (hsTNT) and transthoracic echocardiography (TTE) were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF), mean atrioventricular plane displacement (AVPDm), peak systolic tissue Doppler velocity imaging (TDIs) and velocity time integral in the LV outflow tract (LVOT VTI). LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time), tissue Doppler indices (é, á, E/é) and left atrial volume (La volume). APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores were calculated.
  
  
  RESULTS
  hsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003). Other univariate predictors of mortality were APACHE II (p = 0.009), E/é (p = 0.023), SOFA (p = 0.024) and age (p = 0.031). Survivors and non-survivors did not differ regarding BNP (p = 0.26) or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18). Multivariable logistic regression analysis identified hsTNT (p = 0.010) as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5).
  
  
  CONCLUSIONS
  hsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Institution of Clinical Sciences, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 47, S-20502 , Malmö, Sweden. lill.bergenzaun@skane.se.
authors.forename: Lill
authors.initials: L
authors.lastname: Bergenzaun
authors.forename: Hans
authors.initials: H
authors.lastname: Ohlin
authors.forename: Petri
authors.initials: P
authors.lastname: Gudmundsson
authors.forename: Joachim
authors.initials: J
authors.lastname: Düring
authors.forename: Ronnie
authors.initials: R
authors.lastname: Willenheimer
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Chew