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J Pediatr Intensive Care 2023; 12(03): 203-209
DOI: 10.1055/s-0041-1731432
Original Article

Troponin I as an Independent Biomarker of Outcome in Children with Systemic Inflammatory Response

Heitor P. Leite 
1   Discipline of Nutrition and Metabolism, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
,
Rodrigo Medina
2   Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
,
Emilio L. Junior
1   Discipline of Nutrition and Metabolism, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
,
Tulio Konstantyner
1   Discipline of Nutrition and Metabolism, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
3   Department of Pediatrics, Hospital Geral de Itapecerica da Serra—HGIS, Itapecerica da Serra, São Paulo, Brazil
› Author Affiliations Funding R.M received a grant for scientific initiation from CNPQ, Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (National Council for Scientific and Technological Development).
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Abstract

Cardiac troponin-I (cTnI) is a biomarker of myocardial injury with implications for clinical outcomes. May other contributing factors that could affect outcomes have not been uniformly considered in pediatric studies. We hypothesized that there is an association between admission serum cTnI and outcomes in critically ill children taking into account the magnitude of the acute systemic inflammatory response syndrome (SIRS), serum lactate concentrations, and nutritional status. Second, we tested for potential factors associated with elevated serum cTnI. This was a prospective cohort study in 104 children (median age: 21.3 months) consecutively admitted to a pediatric intensive care unit (PICU) of a teaching hospital with SIRS and without previous chronic diseases. Primary outcome variables were PICU-free days, ventilator-free days, and 30-day mortality. Exposure variables were serum cTnI concentration on admission, revised pediatric index of mortality (PIM2), pediatric logistic organ dysfunction (PELOD-2), hypotensive shock, C-reactive protein, procalcitonin, and serum lactate on admission, and malnutrition. Elevated cTnI (>0.01 μg/L) was observed in 24% of patients, which was associated with the reduction of ventilator-free days (β coefficient = − 4.97; 95% confidence interval [CI]: −8.03; −1.91) and PICU-free days (β coefficient = − 5.76; 95% CI: −8.97; −2.55). All patients who died had elevated serum cTnI. The increase of 0.1 μg/L in cTnI concentration resulted in an elevation of 2 points in the oxygenation index (β coefficient = 2.0; 95% CI: 1.22; 2.78, p < 0.001). The PIM2 score, hypotensive shock in the first 24 hours, and serum lactate were independently associated with elevated cTnI on admission. We conclude that elevated serum cTnI on admission is independently associated with adverse outcomes in children with SIRS and without associated chronic diseases.

Keywords

troponin - septic shock - intensive care unit - pediatric - lactate - children - outcomes

Note

This work was performed in the Department of Pediatrics of Universidade Federal de São Paulo. The data were collected from patients admitted to the intensive care unit of Hospital Geral de Itapecerica da Serra, São Paulo, Brazil.




Publication History

Received: 24 January 2021

Accepted: 17 May 2021

Article published online:
22 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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