title: Admission Plasma Troponin I Is Associated With Mortality in Pediatric Intensive Care.
abstract: Assessment of whether admission plasma troponin I level is associated with mortality or requirement for vasoactive drugs in pediatric intensive care.
  
  
  
  Retrospective cohort study.
  
  
  
  Single centre, tertiary referral general PICU, without a cardiac surgical program.
  
  
  
  Three hundred and nineteen patients 0-18 years old in two cohorts. Cohort 1 was admitted between January 2009 and September 2012 and the cohort 2 between April 2014 and April 2015.
  
  
  
  None.
  
  
  
  Plasma troponin I was measured in patients in cohort 1 only if the attending physician ordered the test due to clinical concern regarding myocardial injury. The second cohort had plasma troponin I routinely measured at admission. The primary outcome was death during PICU admission, and the secondary outcome was maximum inotrope requirement during PICU stay, measured by Vasoactive Inotrope Score. Plasma troponin I was a discriminator for mortality in both cohorts (area under the receiver-operating characteristic curve of 0.73 and 0.86 in cohorts 1 and 2, respectively). In an adjusted analysis using Cox regression, accounting for Pediatric Index of Mortality 2 risk of mortality and age, elevated plasma troponin I was significantly associated with death in both cohorts (hazard ratio, 4.99; p = 0.033; hazard ratio, 10.5; p = 0.026 in cohorts 1 and 2, respectively). Elevated plasma troponin I was only associated with increased Vasoactive Inotrope Score following multivariate analysis in the cohort 2.
  
  
  
  Detectable plasma troponin I at admission to PICU is independently associated with death. The utility of troponin I as a stratification biomarker requires further evaluation.
authors.affiliation: 1Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom. 2Respiratory, Critical Care and Anaesthesia Section (Portex Unit), Institute of Child Health, University College London, London, United Kingdom. 3Department of Chemical Pathology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom. 4Children's Acute Transport Service, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Wilson
authors.forename: Ganesh
authors.initials: G
authors.lastname: Sambandamoorthy
authors.forename: Paul
authors.initials: P
authors.lastname: Holloway
authors.forename: Padmanabhan
authors.initials: P
authors.lastname: Ramnarayan
authors.forename: David P
authors.initials: DP
authors.lastname: Inwald
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010343:Patient Admission; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I