title: Prognostic importance of myocardial injury in critically ill dogs with systemic inflammation.
abstract: BACKGROUND
  In noncardiac critical disease in humans, myocardial injury as detected by cardiac troponin I and T (cTnI and cTnT) has been linked to high intensive care unit (ICU) death independent of prognostic composite scoring.
  
  
  OBJECTIVE
  Presence of myocardial injury predicts short-term death in critically ill dogs with systemic inflammation and provides additional prognostic information when combined with established canine prognostic composite scores.
  
  
  METHODS
  Forty-two dogs admitted to the ICU with evidence of systemic inflammation and no primary cardiac disease.
  
  
  METHODS
  Prospective cohort study. Blood samples were obtained at ICU admission for the measurement of cTnI and cTnT, C-reactive protein, and several cytokines. The acute patient physiologic and laboratory evaluation (APPLE) score and the survival prediction index were calculated within the first 24 hours of admission. Receiver operating characteristic (ROC) curves were used to examine the prognostic capacity of each biomarker and severity score. Multiple logistic regression analysis was performed to evaluate whether cardiac markers significantly contributed to severity scores.
  
  
  RESULTS
  Twenty-eight day case fatality rate was 26% (11/42 dogs). cTnI concentrations were (median [range]) 0.416 [0.004-141.5] ng/mL and cTnT concentrations were 13.5 [<13-3,744] ng/L. cTnI, cTnT, and the APPLE score were all significant prognosticators with areas under the ROC curves [95% CI] of 0.801 [0.649; 0.907], 0.790 [0.637; 0.900], and 0.776 [0.621; 0.889], respectively. cTnI significantly contributed to the APPLE score in providing additional prognostic specificity (P = .025).
  
  
  CONCLUSIONS
  Markers of myocardial injury predict short-term death in dogs with systemic inflammation and cTnI significantly contributes to the APPLE score.
authors.affiliation: Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederksberg C, Denmark. rel@sund.ku.dk
authors.forename: R
authors.initials: R
authors.lastname: Langhorn
authors.forename: M A
authors.initials: MA
authors.lastname: Oyama
authors.forename: L G
authors.initials: LG
authors.lastname: King
authors.forename: M C
authors.initials: MC
authors.lastname: Machen
authors.forename: D J
authors.initials: DJ
authors.lastname: Trafny
authors.forename: V
authors.initials: V
authors.lastname: Thawley
authors.forename: J L
authors.initials: JL
authors.lastname: Willesen
authors.forename: I
authors.initials: I
authors.lastname: Tarnow
authors.forename: M
authors.initials: M
authors.lastname: Kjelgaard-Hansen
mesh_terms: D000818:Animals; D015415:Biomarkers; D015331:Cohort Studies; D016638:Critical Illness; D016207:Cytokines / Q000097:blood / Q000235:genetics / Q000378:metabolism; D004283:Dog Diseases / Q000209:etiology / Q000473:pathology*; D004285:Dogs; D005260:Female; D005786:Gene Expression Regulation; D006331:Heart Diseases / Q000209:etiology / Q000473:pathology / Q000662:veterinary*; D007249:Inflammation / Q000662:veterinary*; D008297:Male; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D016207:Cytokines; D019210:Troponin I
keywords: Biomarker; Cardiac troponin; Companion animals; Severity scores