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Brown M, Lawless S, Roemmich B, Roper SM, Farnsworth CW. Cardiac troponin I is associated with ICU admission in pediatric patients with RSV. Clin Biochem 2025; 136:110896. [PMID: 39965738 DOI: 10.1016/j.clinbiochem.2025.110896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 02/10/2025] [Accepted: 02/11/2025] [Indexed: 02/20/2025]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is associated with morbidity and mortality in pediatric patients, but limited tools exist for prognostication of outcomes that may facilitate more rapid treatment. We assessed the utility of cardiac troponin I (cTnI) to prognosticate intensive care unit (ICU) length of stay (LOS) and bronchiolitis in pediatric patients. METHODS Remnant EDTA plasma from 114 patients 6 months-18 years positive for RSV were enrolled. Forty-five patients with other respiratory infections were included as controls. The electronic medical record was assessed for demographic information. High sensitivity cTnI was assessed on an Abbott ARCHITECT i2000 within 24 h of collection. Proportions were compared using Fisher's exact test and multivariable logistic regression performed. RESULTS Of patients admitted to ICU with RSV, 56.9 % had cTnI ≥ the limit of detection (LOD) compared to 27.0 % of patients not admitted to the ICU. Receiver operator characteristic analysis revealed an area of 0.62 (0.53-0.72) for predicting ICU admission. At the limit of quantitation, cTnI had a sensitivity of 25.8 %, a specificity of 88.9 %, and a positive likelihood ratio of 2.32 for ICU admission. Multivariable logistic regression revealed that log2 increases in cTnI (doubling) was associated with an odds ratio (OR) of 1.34 (95 % CI: 1.03-1.78) for ICU admission. cTnI > the LOD was associated with an OR of 2.37 (1.03-5.57) for ICU admission and bronchiolitis (2.78, 1.09-7.83). CONCLUSIONS Elevated cTnI above the LOD was associated with ICU admission and bronchiolitis in pediatric patients presenting with RSV. Further studies are needed to verify this finding.
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Affiliation(s)
- Meghan Brown
- Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology. Washington University in St. Louis, St. Louis, MO, USA
| | - Sydney Lawless
- Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology. Washington University in St. Louis, St. Louis, MO, USA
| | - Brittany Roemmich
- Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology. Washington University in St. Louis, St. Louis, MO, USA
| | - Stephen M Roper
- Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology. Washington University in St. Louis, St. Louis, MO, USA
| | - Christopher W Farnsworth
- Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology. Washington University in St. Louis, St. Louis, MO, USA.
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Alsagaff MY, Wardhani LFK, Nugraha RA, Putra TS, Khrisna BPD, Al-Farabi MJ, Gunadi RI, Azmi Y, Budianto CP, Fagi RA, Luthfah N, Subagjo A, Oktaviono YH, Lefi A, Dharmadjati BB, Alkaff FF, Pikir BS. Quantification of hs-Troponin Levels and Global Longitudinal Strain among Critical COVID-19 Patients with Myocardial Involvement. J Clin Med 2024; 13:352. [PMID: 38256486 PMCID: PMC10816186 DOI: 10.3390/jcm13020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
Background. Myocardial involvement among critically ill patients with coronavirus disease 2019 (COVID-19) often has worse outcomes. An imbalance in the oxygen supply causes the excessive release of pro-inflammatory cytokines, which results in increased ventilation requirements and the risk of death in COVID-19 patients. Purpose. We evaluated the association between the hs-troponin I levels and global longitudinal strain (GLS) as evidence of myocardial involvement among critical COVID-19 patients. Methods. We conducted a prospective cohort study from 1 February to 31 July 2021 at RSUD Dr. Soetomo, Surabaya, as a COVID-19 referral center. Of the 65 critical COVID-19 patients included, 41 (63.1%) were men, with a median age (interquartile range) of 51.0 years (20.0-75.0). Subjects were recruited based on WHO criteria for severe COVID-19, and myocardial involvement in the form of myocarditis was assessed using CDC criteria. Subjects were examined using echocardiography to measure the GLS, and blood samples were taken to measure the hs-troponin. Subjects were then followed for their need for mechanical ventilation and in-hospital mortality. Results. Severe COVID-19 patients with cardiac injury were associated with an increased need for intubation (78.5%) and an increased incidence of myocarditis (50.8%). There was a relationship between the use of intubation and the risk of death in patients (66.7% vs. 33.3%, p-value < 0.001). Decreased GLS and increased hs-troponin were associated with increased myocarditis (p values < 0.001 and 0.004, respectively). Decreased GLS was associated with a higher need for mechanical ventilation (12.17 + 4.79 vs. 15.65 + 4.90, p-value = 0.02) and higher mortality (11.36 + 4.64 vs. 14.74 + 4.82; p-value = 0.005). Elevated hs-troponin was associated with a higher need for mechanical ventilation (25.33% vs. 3.56%, p-value = 0.002) and higher mortality (34.57% vs. 5.76%, p-value = 0.002). Conclusions. Critically ill COVID-19 patients with myocardial involvement and elevated cardiac troponin levels are associated with a higher need for mechanical ventilation and higher mortality.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Louisa Fadjri Kusuma Wardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Ricardo Adrian Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Tony Santoso Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Bagus Putra Dharma Khrisna
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Makhyan Jibril Al-Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Ruth Irena Gunadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Yusuf Azmi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Christian Pramudita Budianto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Rosi Amrilla Fagi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Nadya Luthfah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Agus Subagjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Achmad Lefi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Budi Baktijasa Dharmadjati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | | | - Budi Susetyo Pikir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
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Leotta C, Hernandez L, Tothova L, Arefin S, Ciceri P, Cozzolino MG, Barany P, Chromek M, Stenvinkel P, Kublickiene K. Levels of Cell-Free DNA in Kidney Failure Patients before and after Renal Transplantation. Cells 2023; 12:2774. [PMID: 38132094 PMCID: PMC10741614 DOI: 10.3390/cells12242774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
Circulating cell-free DNA (cfDNA) has diverse applications in oncological, prenatal, toxicological, cardiovascular, and autoimmune diseases, diagnostics, and organ transplantation. In particular, mitochondrial cfDNA (mt-cfDNA) is associated with inflammation and linked to early vascular ageing (EVA) in end-stage kidney failure (ESKF), which could be a noninvasive marker for graft rejection and organ damage. Plasma samples from 44 ESKF patients, of whom half (n = 22) underwent either conservative therapy (non-HD) or hemodialysis (HD) before kidney transplantation (KT). These samples were analyzed at baseline and two years after KT. cfDNA was extracted from plasma and quantified using the fluorometric method. qPCR was used to quantify and differentiate the fractions of mt-cfDNA and nuclear cfDNA (nc-cfDNA). mt-cfDNA levels in KT patients decreased significantly from baseline to two years post-KT (p < 0.0268), while levels of total cfDNA and nc-cfDNA did not differ. Depending on therapy modality (HD vs. non-HD) before KT, total cfDNA levels were higher in HD patients at both baseline (p = 0.0133) and two years post-KT (p = 0.0421), while nc-cfDNA levels were higher in HD only at baseline (p = 0.0079). Males showed a nonsignificant trend of higher cfDNA levels. Patients with assessed vascular fibrosis (p = 0.0068), either alone or in combination with calcification plus fibrosis, showed reduced mt-cfDNA post-KT (p = 0.0195). Changes in mt-cfDNA levels suggests the impact of KT on the inflammatory state of ESKF, as evidenced via its correlation with high sensitivity C-reactive protein after KT. Further studies are warranted to assess if cfDNA could serve as a noninvasive method for monitoring the response to organ transplantation and even for amelioration of EVA status per se.
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Affiliation(s)
- Chiara Leotta
- Division of Renal Medicine, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 17177 Stockholm, Sweden; (C.L.); (L.H.); (P.B.); (M.C.)
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital Milan, University of Milan, 20142 Milan, Italy (M.G.C.)
| | - Leah Hernandez
- Division of Renal Medicine, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 17177 Stockholm, Sweden; (C.L.); (L.H.); (P.B.); (M.C.)
| | - Lubomira Tothova
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, 81108 Bratislava, Slovakia
| | - Samsul Arefin
- Division of Renal Medicine, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 17177 Stockholm, Sweden; (C.L.); (L.H.); (P.B.); (M.C.)
| | - Paola Ciceri
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital Milan, University of Milan, 20142 Milan, Italy (M.G.C.)
| | - Mario Gennaro Cozzolino
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital Milan, University of Milan, 20142 Milan, Italy (M.G.C.)
| | - Peter Barany
- Division of Renal Medicine, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 17177 Stockholm, Sweden; (C.L.); (L.H.); (P.B.); (M.C.)
| | - Milan Chromek
- Division of Renal Medicine, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 17177 Stockholm, Sweden; (C.L.); (L.H.); (P.B.); (M.C.)
- Division of Pediatrics, Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, 17177 Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 17177 Stockholm, Sweden; (C.L.); (L.H.); (P.B.); (M.C.)
| | - Karolina Kublickiene
- Division of Renal Medicine, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 17177 Stockholm, Sweden; (C.L.); (L.H.); (P.B.); (M.C.)
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Pei XB, Liu B. Research Progress on the Mechanism and Management of Septic Cardiomyopathy: A Comprehensive Review. Emerg Med Int 2023; 2023:8107336. [PMID: 38029224 PMCID: PMC10681771 DOI: 10.1155/2023/8107336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Sepsis is defined as a kind of life-threatening organ dysfunction due to a dysregulated host immune response to infection and is a leading cause of mortality in the intensive care unit. Sepsis-induced myocardial dysfunction, also called septic cardiomyopathy, is a common and serious complication in patients with sepsis, which may indicate a bad prognosis. Although efforts have been made to uncover the pathophysiology of septic cardiomyopathy, a number of uncertainties remain. This article sought to review available literature to summarize the existing knowledge on current diagnostic tools and biomarkers, pathogenesis, and treatments for septic cardiomyopathy.
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Affiliation(s)
- Xue-Bin Pei
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Bo Liu
- Department of Emergency Medicine, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
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Hinton J, Augustine M, Gabara L, Mariathas M, Allan R, Borca F, Nicholas Z, Gillett N, Kwok CS, Cook P, Grocott MPW, Mamas M, Curzen N. Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients? J Intensive Care Soc 2023; 24:392-398. [PMID: 37841295 PMCID: PMC10572482 DOI: 10.1177/17511437231160078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
The aim of this study was to assess whether high sensitivity troponin (hs-cTnI) is associated with 1 year mortality in critical care (CC). One year mortality data were obtained from NHS Digital for a consecutive cohort of patients admitted to general CC unit (GCCU) and neuroscience CC unit (NCCU) who had hs-cTnI tests performed throughout their CC admission, regardless of whether the test was clinically indicated. Cox proportional hazards were used to estimate the risk of 1-year mortality. A landmark analysis was undertaken to assess whether any relationship at 1 year was driven by mortality within the first 30 days. A total of 1033 consecutive patients were included. At 1 year 254 (24.6%) patients had died. The admission log(10)hs-cTnI concentration in the entire cohort (HR 1.35 (95% CI 1.05-1.75) p = 0.009 with a bootstrap of 1000 samples) was independently associated with 1 year mortality. On landmark analysis the association with 1 year mortality was driven by 30 day mortality. These results indicate that admission hs-cTnI concentration is independently associated with 1 year mortality in CC and this relationship may be driven by differences in mortality at 30 days.
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Affiliation(s)
- Jonathan Hinton
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Maclyn Augustine
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lavinia Gabara
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark Mariathas
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rick Allan
- Department of Biochemistry, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Florina Borca
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zoe Nicholas
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Neil Gillett
- Department of Biochemistry, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - Paul Cook
- Department of Biochemistry, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael PW Grocott
- Faculty of Medicine, University of Southampton, Southampton, UK
- Anaesthesia and Critical Care Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Xu KZ, Xu P, li JJ, Zuo AF, Wang SB, Han F. Predictors and nomogram of in-hospital mortality in sepsis-induced myocardial injury: a retrospective cohort study. BMC Anesthesiol 2023; 23:230. [PMID: 37420185 PMCID: PMC10327384 DOI: 10.1186/s12871-023-02189-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Sepsis-induced myocardial injury (SIMI) is a common organ dysfunction and is associated with higher mortality in patients with sepsis. We aim to construct a nomogram prediction model to assess the 28-day mortality in patients with SIMI. . METHOD We retrospectively extracted data from Medical Information Mart for Intensive Care (MIMIC-IV) open-source clinical database. SIMI was defined by Troponin T (higher than the 99th percentile of upper reference limit value) and patients with cardiovascular disease were excluded. A prediction model was constructed in the training cohort by backward stepwise Cox proportional hazards regression model. The concordance index (C-index), area under the receiver operating characteristics curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting and decision-curve analysis (DCA) were used to evaluate the nomogram. RESULTS 1312 patients with sepsis were included in this study and 1037 (79%) of them presented with SIMI. The multivariate Cox regression analysis in all septic patients revealed that SIMI was independently associated with 28-day mortality of septic patients. The risk factors of diabetes, Apache II score, mechanical ventilation, vasoactive support, Troponin T and creatinine were included in the model and a nomogram was constructed based on the model. The C-index, AUC, NRI, IDI, calibration plotting and DCA showed that the performance of the nomogram was better than the single SOFA score and Troponin T. CONCLUSION SIMI is related to the 28-day mortality of septic patients. The nomogram is a well-performed tool to predict accurately the 28-day mortality in patients with SIMI.
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Affiliation(s)
- Kai-Zhi Xu
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310000 China
| | - Ping Xu
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310000 China
| | - Juan-Juan li
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310000 China
| | - A-Fang Zuo
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310000 China
| | - Shu-Bao Wang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310000 China
| | - Fang Han
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310000 China
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Perioperative troponin surveillance in major noncardiac surgery: a narrative review. Br J Anaesth 2023; 130:21-28. [PMID: 36464518 DOI: 10.1016/j.bja.2022.08.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/08/2022] [Accepted: 08/31/2022] [Indexed: 12/03/2022] Open
Abstract
Myocardial injury is now an acknowledged complication in patients undergoing noncardiac surgery. Heterogeneity in the definitions of myocardial injury contributes to difficulty in evaluating the value of cardiac troponins (cTns) measurement in perioperative care. Pre-, post-, and peri-operatively increased cTns are encompassed by the umbrella term 'myocardial injury' and are likely to reflect different pathophysiological mechanisms. Increased cTns are independently associated with cardiovascular and non-cardiovascular complications, poor short-term and long-term cardiovascular outcomes, and increased mortality. Preoperative measurement of cTns aids preoperative risk stratification beyond the Revised Cardiac Risk Index. Systematic measurement detects acute perioperative increases and allows early identification of acute myocardial injury. Common definitions and standards for reporting are a prerequisite for designing impactful future trials and perioperative management strategies.
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8
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Mani I, Alexopoulos T, Vasilieva L, Alexopoulou A. Serum troponin is elevated in acute decompensation and acute-on-chronic liver failure and is associated with severity of liver disease and short-term mortality. Scand J Gastroenterol 2022:1-7. [PMID: 36424717 DOI: 10.1080/00365521.2022.2131333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of high sensitive cardiac Troponin (hs-cTn) in patients with liver cirrhosis (LC) and liver-related acute events is not well established. AIM To assess the prognostic performance of hs-cTn I in acute decompensation (AD) and acute-on-chronic liver failure (ACLF). METHODS Two cohorts of consecutive patients, a derivation (retrospective) and a validation (prospective), were evaluated and 30-day-mortality was recorded. Hs-cTnI values were measured. Very low hs-cTnΙ (4 ng/L) was considered the cutoff-level. RESULTS A total of 296 patients with LC [69.3% male, median age 57 (IQR 51-68) years, MELD score 19 (13-25), ACLF (29.4%), AD (48.3%), and without liver-related acute events (22.3%)] were included in the derivation cohort. The 66.2% of total patients had hs-cTnI ≥4 ng/L. Patients with hs-cTnI ≥4 ng/L were older and had more severe LC compared to those with <4ng/L. The multivariate analysis demonstrated that age (p < 0.001) and MELD (p = 0.001) were independent variables associated with elevated hs-cTnI after adjustment for age, sex and hepatic encephalopathy in total patients.When ACLF and AD were analyzed separately, the mortality was higher in patients with hs-cTnI ≥ 4 ng/L compared to lower values (log-rank p = 0.036 and p = 0.019, respectively). In multivariate analysis, MELD (p < 0.001) and hs-cTnI ≥4 ng/L (p = 0.032) were independent prognostic factors of mortality in ACLF/AD groups, after adjustment for age and sex. Similar results were obtained from the validation cohort (N = 148). CONCLUSIONS hs-cTnI levels were higher in patients with severe liver disease. The low cutoff-point of 4 ng/L is accurate in ruling out non-survivors mainly in AD group.
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Affiliation(s)
- Iliana Mani
- 2nd Department of Internal Medicine and Research Laboratory, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Theodoros Alexopoulos
- 2nd Department of Internal Medicine and Research Laboratory, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | | | - Alexandra Alexopoulou
- 2nd Department of Internal Medicine and Research Laboratory, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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9
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Jacobsen DP, Røysland R, Strand H, Moe K, Sugulle M, Omland T, Staff AC. Circulating cardiovascular biomarkers during and after preeclampsia: Crosstalk with placental function? Pregnancy Hypertens 2022; 30:103-109. [PMID: 36148698 DOI: 10.1016/j.preghy.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women, yet sex-specific risk factors remain understudied. Preeclampsia and other adverse pregnancy outcomes imply an increased maternal cardiovascular risk. We hypothesized that cardiac troponin T (cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) are increased in such pregnancies and correlate with markers of placental dysfunction. We also investigated these cardiovascular biomarkers 1 or 3 years postpartum. Prior to delivery, we included serum from 417 pregnant women: 55 early-onset preeclampsia (EO-PE), 63 late-onset preeclampsia (LO-PE), 30 gestational hypertension (GH) and 269 healthy controls. Postpartum, we included 341 women 1 or 3 years after delivery: 26 EO-PE, 107 LO-PE, 61 GH, and 147 healthy pregnancies. Prior to delivery, median cTnT and NT-proBNP concentrations were higher in women with EO-PE, LO-PE, or GH than in controls. Median GDF-15 was higher in EO-PE and LO-PE compared to controls. Postpartum, GDF-15 was elevated in women with previous EO-PE. Markers of placental dysfunction correlated with CVD biomarkers in pregnancy, but not postpartum. Our findings underscore the cardiovascular burden of hypertensive disorders of pregnancy and the crosstalk with placental function. The upregulation of circulating GDF-15 following early-onset preeclampsia is in line with the epidemiological excessive risk of premature CVD in this group of women. GDF-15 may be explored for targeting postpartum women with most to gain from intensified preventive follow-up for CVD.
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Affiliation(s)
- Daniel P Jacobsen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway.
| | - Ragnhild Røysland
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Kjartan Moe
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Obstetrics and Gynaecology, Bærum Hospital, Vestre Viken HF, Norway
| | - Meryam Sugulle
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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Xue W, Pang J, Liu J, Wang H, Guo H, Chen Y. Septic cardiomyopathy: characteristics, evaluation, and mechanism. EMERGENCY AND CRITICAL CARE MEDICINE 2022; 2:135-147. [DOI: 10.1097/ec9.0000000000000060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Abstract
Sepsis is a common clinical disease; if there is no early active treatment, it is likely to develop into multiple organ dysfunction syndrome and even cause death. Septic cardiomyopathy is a complication of sepsis-related cardiovascular failure, characterized by reversible left ventricular dilatation and decreased ventricular systolic and/or diastolic function. At present, echocardiography and biomarkers are often used to screen septic cardiomyopathy in clinics. Although there is still a lack of clear diagnostic criteria for septic cardiomyopathy, according to existing studies, the pathogenesis of several septic cardiomyopathy has been clarified, such as immune response caused by infection and mitochondrial dysfunction. This review summarizes the characteristics, pathophysiology, and diagnosis of septic cardiomyopathy and focuses on the mechanisms of infection immunity and mitochondrial dysfunction.
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Affiliation(s)
| | | | - Jiao Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Zhang H, Wang X, Yin W, Zhang H, Liu L, Pan P, Zhu Y, Huang W, Xing Z, Yao B, Wang C, Lin T, Yu R, Shang X. A multicenter prospective cohort study of cardiac ultrasound phenotypes in patients with sepsis: Study protocol for a multicenter prospective cohort trial. Front Med (Lausanne) 2022; 9:938536. [PMID: 35966841 PMCID: PMC9363883 DOI: 10.3389/fmed.2022.938536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sepsis-induced cardiomyopathy significantly increased the mortality of patients with sepsis. The diagnostic criteria for septic cardiomyopathy has not been unified, which brings serious difficulties to clinical treatment. This study aimed to provide evidence for the early identification and intervention in patients with sepsis by clarifying the relationship between the ultrasound phenotype of septic cardiomyopathy and the prognosis of patients with sepsis. Methods This was a multicenter, prospective cohort study. The study population will consist of all eligible consecutive patients with sepsis or septic shock who meet the Sepsis 3.0 diagnostic criteria and were aged ≥18 years. Clinical data and echocardiographic measurements will be recorded within 2 h, at the 24th hour, at the 72nd hour, and on the 7th day after admission. The prevalence of each phenotype will be described as well, and their association with prognosis will be analyzed statistically. Discussion To achieve early recognition, prevent reinjury, achieve precise treatment, and reduce mortality in patients with sepsis, it is important to identify septic cardiac alterations and classify the phenotypes at all stages of sepsis. First, there is a lack of studies on the prevalence of each phenotype in Chinese populations. Second, each phenotype and its corresponding prognosis are not clear. In addition, the prognosis of patients with normal cardiac ultrasound phenotypes vs. those with suppressed or hyperdynamic cardiac phenotypes is unclear. Finally, this study was designed to collect data at four specific timing, then the timing of occurrence, duration, changes over time, impact to outcomes of each phenotype will probably be found. This study is expected to establish a standard and objective method to assess the ultrasound phenotype of septic cardiomyopathy due to its advantages of visualization, non-invasiveness and reproducibility, and to provide more precise information for the hemodynamic management of septic patients. In addition, this research will promote the clinical application of critical care ultrasound, which will play an important role in medical education and make ultrasound the best method to assess cardiac changes in sepsis. Trial registration https://clinicaltrials.gov/ct2/show/NCT05161104, identifier NCT05161104.
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Affiliation(s)
- Hongxuan Zhang
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xiaoting Wang
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hongmin Zhang
- Department of Critical Care Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lixia Liu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pan Pan
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Ying Zhu
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Huang
- Department of Critical Care Medicine, School of Medicine, First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Zhiqun Xing
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bo Yao
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cui Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianlai Lin
- Department of Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Rongguo Yu
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
- Rongguo Yu
| | - Xiuling Shang
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
- Xiuling Shang
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12
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Owen A, Patel JM, Parekh D, Bangash MN. Mechanisms of Post-critical Illness Cardiovascular Disease. Front Cardiovasc Med 2022; 9:854421. [PMID: 35911546 PMCID: PMC9334745 DOI: 10.3389/fcvm.2022.854421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during and beyond the convalescent phase. New cardiovascular and renal disease is commonly seen and roughly one third of all deaths in the year following discharge from critical care may come from this cluster of diseases. During prolonged critical care stays, the immunometabolic, inflammatory and neurohumoral response to severe illness in conjunction with resuscitative treatments primes the immune system and parenchymal tissues to develop a long-lived pro-inflammatory and immunosenescent state. This state is perpetuated by persistent Toll-like receptor signaling, free radical mediated isolevuglandin protein adduct formation and presentation by antigen presenting cells, abnormal circulating HDL and LDL isoforms, redox and metabolite mediated epigenetic reprogramming of the innate immune arm (trained immunity), and the development of immunosenescence through T-cell exhaustion/anergy through epigenetic modification of the T-cell genome. Under this state, tissue remodeling in the vascular, cardiac, and renal parenchymal beds occurs through the activation of pro-fibrotic cellular signaling pathways, causing vascular dysfunction and atherosclerosis, adverse cardiac remodeling and dysfunction, and proteinuria and accelerated chronic kidney disease.
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Affiliation(s)
- Andrew Owen
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jaimin M. Patel
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dhruv Parekh
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mansoor N. Bangash
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Mansoor N. Bangash
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13
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Wyatt L, Kamat G, Moyer J, Weaver AM, Diaz-Sanchez D, Devlin RB, Di Q, Schwartz JD, Cascio WE, Ward-Caviness CK. Associations between short-term exposure to PM 2.5 and cardiomyocyte injury in myocardial infarction survivors in North Carolina. Open Heart 2022; 9:openhrt-2021-001891. [PMID: 35750420 PMCID: PMC9234784 DOI: 10.1136/openhrt-2021-001891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/23/2022] [Indexed: 12/20/2022] Open
Abstract
Objective Short-term ambient fine particulate matter (PM2.5) is associated with adverse cardiovascular events including myocardial infarction (MI). However, few studies have examined associations between PM2.5 and subclinical cardiomyocyte damage outside of overt cardiovascular events. Here we evaluate the impact of daily PM2.5 on cardiac troponin I, a cardiomyocyte specific biomarker of cellular damage. Methods We conducted a retrospective cohort study of 2924 patients identified using electronic health records from the University of North Carolina Healthcare System who had a recorded MI between 2004 and 2016. Troponin I measurements were available from 2014 to 2016, and were required to be at least 1 week away from a clinically diagnosed MI. Daily ambient PM2.5 concentrations were estimated at 1 km resolution and assigned to patient residence. Associations between log-transformed troponin I and daily PM2.5 were evaluated using distributed lag linear mixed effects models adjusted for patient demographics, socioeconomic status and meteorology. Results A 10 µg/m3 elevation in PM2.5 3 days before troponin I measurement was associated with 0.06 ng/mL higher troponin I (95% CI=0.004 to 0.12). In stratified models, this association was strongest in patients that were men, white and living in less urban areas. Similar associations were observed when using 2-day rolling averages and were consistently strongest when using the average exposure over the 5 days prior to troponin I measurement. Conclusions Daily elevations in PM2.5 were associated with damage to cardiomyocytes, outside of the occurrence of an MI. Poor air quality may cause persistent damage to the cardiovascular system leading to increased risk of cardiovascular disease and adverse cardiovascular events.
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Affiliation(s)
- Lauren Wyatt
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Gauri Kamat
- Brown University, Providence, Rhode Island, USA
| | - Joshua Moyer
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Anne M Weaver
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - David Diaz-Sanchez
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Robert B Devlin
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Qian Di
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Joel D Schwartz
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Harvard University, Boston, Massachusetts, USA
| | - Wayne E Cascio
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Cavin K Ward-Caviness
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
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14
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Graphene-Based Biosensors for Molecular Chronic Inflammatory Disease Biomarker Detection. BIOSENSORS 2022; 12:bios12040244. [PMID: 35448304 PMCID: PMC9030187 DOI: 10.3390/bios12040244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Chronic inflammatory diseases, such as cancer, diabetes mellitus, stroke, ischemic heart diseases, neurodegenerative conditions, and COVID-19 have had a high number of deaths worldwide in recent years. The accurate detection of the biomarkers for chronic inflammatory diseases can significantly improve diagnosis, as well as therapy and clinical care in patients. Graphene derivative materials (GDMs), such as pristine graphene (G), graphene oxide (GO), and reduced graphene oxide (rGO), have shown tremendous benefits for biosensing and in the development of novel biosensor devices. GDMs exhibit excellent chemical, electrical and mechanical properties, good biocompatibility, and the facility of surface modification for biomolecular recognition, opening new opportunities for simple, accurate, and sensitive detection of biomarkers. This review shows the recent advances, properties, and potentialities of GDMs for developing robust biosensors. We show the main electrochemical and optical-sensing methods based on GDMs, as well as their design and manufacture in order to integrate them into robust, wearable, remote, and smart biosensors devices. We also describe the current application of such methods and technologies for the biosensing of chronic disease biomarkers. We also describe the current application of such methods and technologies for the biosensing of chronic disease biomarkers with improved sensitivity, reaching limits of detection from the nano to atto range concentration.
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Zhang Q, Wang YF, Hu X, Tan YJ, Gao C, Chen J, Han F, Chen J, Yang Y. Association of serum cardiac troponin I and severity of coronary stenosis in patients with varied renal functions: a retrospective cohort study. BMJ Open 2022; 12:e054722. [PMID: 35351712 PMCID: PMC8961110 DOI: 10.1136/bmjopen-2021-054722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Recent studies showed cardiac troponin I (cTnI) might be a non-invasive biomarker to estimate the severity of coronary stenosis. However, serum cTnI is also found associated with renal function. The study objective is to analyse the association of serum cTnI and severity of coronary stenosis in patients with varied renal functions. DESIGN A retrospective cohort study. SETTING The First Affiliated Hospital, College of Medicine, Zhejiang University in Hangzhou, China. POPULATION A total of 6487 subjects who underwent elective coronary angiography between January 2017 to June 2020 were involved in this study. PRIMARY OUTCOMES Severity of coronary stenosis was divided into three degrees based on Gensini score, mild coronary stenosis, moderate coronary stenosis and severe coronary stenosis. RESULTS By using ordinal logistic regression, serum cTnI was associated with severity of coronary stenosis (OR=1.14, p<0.05). By construction and comparison of two models for predicting severity of coronary stenosis, the addition of cTnI significantly improved the predictive ability of the model. Differences between areas under the curves were 0.03, 0.03, 0.03, 0.12 (all p<0.05). Net reclassification improvements were 0.08, 0.05, 0.05, 0.35, respectively, in varied renal functions. Compared with the participants with normal renal function and without hypertroponinaemia, groups of participants with hypertroponinaemia showed higher ORs. ORs were 3.52, 4.20, 4.45, 6.00, respectively, as renal function decreased (all p<0.05). CONCLUSIONS In this cohort of patients with stable coronary artery disease and varied renal functions, cTnI was intensely associated with severity of coronary stenosis which based on Gensini score. The presentation of hypertroponinaemia in patients with impaired renal function always indicates a higher risk of severe coronary stenosis.
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Affiliation(s)
- Qian Zhang
- Kidney disease center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yong-Fei Wang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Xiao Hu
- Department of Clinical Laboratory, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ya-Jun Tan
- Department of Clinical Laboratory, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cui Gao
- Kidney disease center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianxiao Chen
- Department of Nephrology, the Forth Affiliated Hospital, College of Medicine,Zhejiang University, Yiwu, Zhejiang, China
| | - Fei Han
- Kidney disease center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianghua Chen
- Department of Nephrology, the Forth Affiliated Hospital, College of Medicine,Zhejiang University, Yiwu, Zhejiang, China
| | - Yi Yang
- Kidney disease center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Wen K, Du H, Tang B, Xiong B, Zhang A, Wang P. Complete Blood Count and Myocardial Markers Combination with Sequential Organ Failure Assessment Score Can Effectively Predict the Mortality in Sepsis: A Derivation and Validation Study. Int J Gen Med 2022; 15:3265-3280. [PMID: 35355798 PMCID: PMC8958200 DOI: 10.2147/ijgm.s349751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/08/2022] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of our study was to explore the prognostic value of complete blood count and myocardial markers combination with Sequential Organ Failure Assessment (SOFA) score in predicting the 28-day mortality among sepsis patients. Patients and methods A retrospective observational cohort study was performed. Three hundred and nineteen sepsis patients who were hospitalized at the Second Affiliated Hospital of Chongqing Medical University, China, from January 2019 to September 2021 were included. The clinical and laboratory data, the Acute Physiological and Chronic Health Evaluation II (APACHE II) score and SOFA score at the time of the initial sepsis diagnosis were collected, and the predictive values of the single and combination variables for 28-day mortality were compared. Results The derivation cohort consisted of 221 patients and included 59 (26.7%) died. The area under the curve (AUC) [95% confidence interval (CI)] of RDW and cTnT were 0.735 (0.663–0.807) and 0.753 (0.678–0.827) for mortality, and the cut-off value were 14.05% and 0.039 ng/mL, respectively. The combination of RDW, cTnT and the SOFA score showed a better performance for the prediction of mortality, and the AUC was significantly higher than that of the SOFA score (0.791 vs 0.726, DeLong test: P=0.032). Multivariate Cox analysis identified that the combination of RDW, cTnT and the SOFA score (HR=6.133, P=0.004) and APACHE II score (HR=1.093, P<0.001) were independent detrimental factors for 28-day mortality. The validation cohort consisted of 98 patients and included 23 (23.5%) died. Similarly, the AUC of the RDW, cTnT and the SOFA score combination is significantly higher than that of the SOFA score (0.821 vs 0.739, DeLong test: P=0.035). Conclusion RDW and cTnT showed good performance in predicting 28-day mortality rates among patients with sepsis. Combined RDW and cTnT with the SOFA score can significantly improve the predictive value of SOFA score for the prognosis of sepsis.
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Affiliation(s)
- Keli Wen
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Hu Du
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Binfei Tang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Bin Xiong
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - An Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
- Correspondence: An Zhang; Pengfei Wang, Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, People’s Republic of China, Tel +86 23-63693452, Email ;
| | - Pengfei Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
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Etiology of Myocardial Injury in Critically Ill Patients with Sepsis: A Cohort Study. Ann Am Thorac Soc 2021; 19:773-780. [PMID: 34784496 DOI: 10.1513/annalsats.202106-689oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Myocardial injury occurs frequently during sepsis and is independently associated with mortality. However, its etiology remains largely unknown. OBJECTIVE Our aim was to assess the relative contributions of hyperinflammation, activated coagulation, and endothelial dysfunction to myocardial injury in critically ill patients with sepsis. METHODS We included consecutive patients with sepsis presenting to two tertiary intensive care units in the Netherlands between 2011 and 2013. High-sensitivity cardiac troponin I (hscTnI), as well as a wide range of plasma biomarkers related to inflammation, coagulation, and endothelial function were measured. Structural equation modeling (SEM) was used to construct latent variables representing each of these pathophysiological constructs, and to subsequently study their associations with troponin elevation while adjusting for confounders. RESULTS We analyzed 908 (88%) of 1037 eligible patients, 553 (61%) of whom had raised hs-cTnI levels upon intensive care unit admission. The latent variables included interleukin (IL)-6, IL-8 and IL-1β for inflammation; platelet count, prothrombin time and protein C for coagulation; and sE-selectin, intercellular adhesion molecule-1 and angiopoietin-2 for endothelial function. After adjustment for age and cardiovascular comorbidities, SEM analysis showed that activated coagulation was independently associated with elevated troponin during sepsis (standardized regression coefficient 0.551, 95% CI 0.257-0.845, p-value <0.001), whereas hyperinflammation and endothelial dysfunction were not (standardized regression coefficients -0.161, 95% CI -0.418-0.096, and -0.054, 95% CI -0.168-0.060, respectively). CONCLUSIONS Our findings suggest that myocardial injury during sepsis is mediated by systemic activation of coagulation, rather than by circulating inflammatory mediators or by activation of the endothelium. These findings may guide evaluation of strategies to protect the myocardium during sepsis. Clinical trial registered with clinicaltrials.gov (NCT01905033).
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18
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Ghio S, Montalto C, Pagnesi M, Lupi L, Cappelletti A, Baldetti L, Baldi E, Lombardi C, Metra M, Perlini S, Oltrona Visconti L. High troponin levels in patients hospitalized for coronavirus disease 2019: a maker or a marker of prognosis? J Cardiovasc Med (Hagerstown) 2021; 22:828-831. [PMID: 34519287 DOI: 10.2459/jcm.0000000000001249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS Controversial data have been published regarding the prognostic role of cardiac troponins in patients who need hospitalization because of coronavirus disease 2019 (COVID-19). The aim of the study was to assess the role of high-sensitivity troponin plasma levels and of respiratory function at admission on all-cause deaths in unselected patients hospitalized because of COVID-19. METHODS We pooled individual patient data from observational studies that assessed all-cause mortality of unselected patients hospitalized for COVID-19. The individual data of 722 patients were included. The ratio of partial pressure arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) and high-sensitivity troponins was reported at admission in all patients. This meta-analysis was registered on PROSPERO (CRD42020213209). RESULTS After a median follow-up of 14 days, 180 deaths were observed. At multivariable regression analysis, age [hazard ratio (HR) 1.083, 95% confidence interval (CI) 1.061-1.105, P < 0.0001], male sex (HR 2.049, 95% CI 1.319-3.184, P = 0.0014), moderate-severe renal dysfunction (estimated glomerular filtration rate < 30 mL/min/m2) (HR 2.108, 95% CI 1.237-3.594, P = 0.0061) and lower PaO2/FiO2 (HR 0.901, 95% CI 0.829-0.978, P = 0.0133) were the independent predictors of death. A linear increase in the HR was associated with decreasing values of PaO2/FiO2 below the normality threshold. On the contrary, the HR curve for troponin plasma levels was near-flat with large CI for values above the normality thresholds. CONCLUSION In unselected patients hospitalized for COVID-19, mortality is mainly driven by male gender, older age and respiratory failure. Elevated plasma levels of high-sensitivity troponins are not an independent predictor of worse survival when respiratory function is accounted for.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Matteo Pagnesi
- Cardiac Intensive Care Unit, San Raffaele Scientific Institute, Milan
| | - Laura Lupi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | | | - Luca Baldetti
- Cardiac Intensive Care Unit, San Raffaele Scientific Institute, Milan
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo
| | - Carlo Lombardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Stefano Perlini
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia and Department of Internal Medicine, University of Pavia, Pavia, Italy
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19
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Abstract
Sepsis is the life-threatening organ dysfunction caused by a dysregulated host response to infection and is the leading cause of death in intensive care units. Cardiac dysfunction caused by sepsis, usually termed sepsis-induced cardiomyopathy, is common and has long been a subject of interest. In this Review, we explore the definition, epidemiology, diagnosis and pathophysiology of septic cardiomyopathy, with an emphasis on how best to interpret this condition in the clinical context. Advances in diagnostic techniques have increased the sensitivity of detection of myocardial abnormalities but have posed challenges in linking those abnormalities to therapeutic strategies and relevant clinical outcomes. Sophisticated methodologies have elucidated various pathophysiological mechanisms but the extent to which these are adaptive responses is yet to be definitively answered. Although the indications for monitoring and treating septic cardiomyopathy are clinical and directed towards restoring tissue perfusion, a better understanding of the course and implications of septic cardiomyopathy can help to optimize interventions and improve clinical outcomes.
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20
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Jirak P, Larbig R, Shomanova Z, Fröb EJ, Dankl D, Torgersen C, Frank N, Mahringer M, Butkiene D, Haake H, Salzer HJ, Tschoellitsch T, Lichtenauer M, Egle A, Lamprecht B, Reinecke H, Hoppe UC, Pistulli R, Motloch LJ. Myocardial injury in severe COVID-19 is similar to pneumonias of other origin: results from a multicentre study. ESC Heart Fail 2021; 8:37-46. [PMID: 33350605 PMCID: PMC7835505 DOI: 10.1002/ehf2.13136] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/16/2020] [Accepted: 11/15/2020] [Indexed: 01/14/2023] Open
Abstract
AIMS COVID-19, a respiratory viral disease causing severe pneumonia, also affects the heart and other organs. Whether its cardiac involvement is a specific feature consisting of myocarditis, or simply due to microvascular injury and systemic inflammation, is yet unclear and presently debated. Because myocardial injury is also common in other kinds of pneumonias, we investigated and compared such occurrence in severe pneumonias due to COVID-19 and other causes. METHODS AND RESULTS We analysed data from 156 critically ill patients requiring mechanical ventilation in four European tertiary hospitals, including all n = 76 COVID-19 patients with severe disease course requiring at least ventilatory support, matched to n = 76 from a retrospective consecutive patient cohort of severe pneumonias of other origin (matched for age, gender, and type of ventilator therapy). When compared to the non-COVID-19, mortality (COVID-19 = 38.2% vs. non-COVID-19 = 51.3%, P = 0.142) and impairment of systolic function were not significantly different. Surprisingly, myocardial injury was even more frequent in non-COVID-19 (96.4% vs. 78.1% P = 0.004). Although inflammatory activity [C-reactive protein (CRP) and interleukin-6] was indifferent, d-dimer and thromboembolic incidence (COVID-19 = 23.7% vs. non-COVID-19 = 5.3%, P = 0.002) driven by pulmonary embolism rates (COVID-19 = 17.1% vs. non-COVID-19 = 2.6%, P = 0.005) were higher. CONCLUSIONS Myocardial injury was frequent in severe COVID-19 requiring mechanical ventilation, but still less frequent than in similarly severe pneumonias of other origin, indicating that cardiac involvement may not be a specific feature of COVID-19. While mortality was also similar, COVID-19 is characterized with increased thrombogenicity and high pulmonary embolism rates.
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Affiliation(s)
- Peter Jirak
- Clinic II for Internal MedicineUniversity Hospital Salzburg, Paracelsus Medical UniversitySalzburgAustria
| | - Robert Larbig
- Division of CardiologyHospital Maria Hilf MönchengladbachMönchengladbachGermany
- Division of Electrophysiology, Department of Cardiovascular MedicineUniversity of MünsterMünsterGermany
| | - Zornitsa Shomanova
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterAlbert Schweitzer Campus 1, A1Münster48149Germany
| | - Elisabeth J. Fröb
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterAlbert Schweitzer Campus 1, A1Münster48149Germany
| | - Daniel Dankl
- Department of Anesthesiology, Perioperative Care, and Intensive Care MedicineUniversity Hospital Salzburg, Paracelsus Medical UniversitySalzburgAustria
| | - Christian Torgersen
- Department of Anesthesiology, Perioperative Care, and Intensive Care MedicineUniversity Hospital Salzburg, Paracelsus Medical UniversitySalzburgAustria
| | - Nino Frank
- Department of Anesthesiology, Perioperative Care, and Intensive Care MedicineUniversity Hospital Salzburg, Paracelsus Medical UniversitySalzburgAustria
| | - Magdalena Mahringer
- Clinic II for Internal MedicineUniversity Hospital Salzburg, Paracelsus Medical UniversitySalzburgAustria
| | - Dominyka Butkiene
- Division of CardiologyHospital Maria Hilf MönchengladbachMönchengladbachGermany
| | - Hendrik Haake
- Division of CardiologyHospital Maria Hilf MönchengladbachMönchengladbachGermany
| | | | - Thomas Tschoellitsch
- Department of Anesthesiology and Intensive Care MedicineKepler University Hospital Linz, Johannes‐Kepler‐UniversityLinzAustria
| | - Michael Lichtenauer
- Clinic II for Internal MedicineUniversity Hospital Salzburg, Paracelsus Medical UniversitySalzburgAustria
| | - Alexander Egle
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious DiseasesParacelsus Medical UniversitySalzburgAustria
| | - Bernd Lamprecht
- Department of PulmonologyKepler University HospitalLinzAustria
| | - Holger Reinecke
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterAlbert Schweitzer Campus 1, A1Münster48149Germany
| | - Uta C. Hoppe
- Clinic II for Internal MedicineUniversity Hospital Salzburg, Paracelsus Medical UniversitySalzburgAustria
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterAlbert Schweitzer Campus 1, A1Münster48149Germany
| | - Lukas J. Motloch
- Clinic II for Internal MedicineUniversity Hospital Salzburg, Paracelsus Medical UniversitySalzburgAustria
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21
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Tsuruda T, Yoshikawa N, Kai M, Yamaguchi M, Toida R, Kodama T, Kajihara K, Kawabata T, Nakamura T, Sakata K, Hatakeyama K, Gi T, Asada Y, Tono T, Kitamura K, Ikeda R. The Cytokine Expression in Patients with Cardiac Complication after Immune Checkpoint Inhibitor Therapy. Intern Med 2021; 60:423-429. [PMID: 32963156 PMCID: PMC7925267 DOI: 10.2169/internalmedicine.5317-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We herein report the cytokine expression at different stages for three patients who developed cardiac complications after immune checkpoint inhibitor (ICI) therapy. Case 1 with biopsy-proven myocarditis showed increased levels of interleukin (IL)-8, monocyte chemotactic and activating factor, and granulocyte macrophage colony-stimulating factor (GM-CSF) when he developed Takotsubo cardiomyopathy. Case 2 with subclinical myocarditis showed predominant activation of IL-8 during the progressive clinical course. Case 3 with cytokine-releasing syndrome showed substantial activations of IL-6, IL-8, GM-CSF, and interferon-γ. Our data suggest the development of unique cytokine activation in individual patients with cardiac complications after ICI therapy.
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Affiliation(s)
- Toshihiro Tsuruda
- Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Japan
| | - Naoki Yoshikawa
- Department of Pharmacy, University of Miyazaki Hospital, Japan
| | - Motoaki Kai
- Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Japan
| | - Masashi Yamaguchi
- Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Japan
| | - Reiko Toida
- Department of Cardiology, Chiyoda Hospital, Japan
| | | | - Kei Kajihara
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Miyazaki, Japan
| | - Takayuki Kawabata
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Miyazaki, Japan
| | - Takeshi Nakamura
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Miyazaki, Japan
| | - Koji Sakata
- Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Japan
| | - Toshihiro Gi
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Japan
| | - Yujiro Asada
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Japan
| | - Tetsuya Tono
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Miyazaki, Japan
| | - Kazuo Kitamura
- Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Japan
| | - Ryuji Ikeda
- Department of Pharmacy, University of Miyazaki Hospital, Japan
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Soussi S, Collins GS, Jüni P, Mebazaa A, Gayat E, Le Manach Y. Evaluation of Biomarkers in Critical Care and Perioperative Medicine: A Clinician’s Overview of Traditional Statistical Methods and Machine Learning Algorithms. Anesthesiology 2021; 134:15-25. [PMID: 33216849 DOI: 10.1097/aln.0000000000003600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Interest in developing and using novel biomarkers in critical care and perioperative medicine is increasing. Biomarkers studies are often presented with flaws in the statistical analysis that preclude them from providing a scientifically valid and clinically relevant message for clinicians. To improve scientific rigor, the proper application and reporting of traditional and emerging statistical methods (e.g., machine learning) of biomarker studies is required. This Readers' Toolbox article aims to be a starting point to nonexpert readers and investigators to understand traditional and emerging research methods to assess biomarkers in critical care and perioperative medicine.
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23
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El-Sayed Mahmoud Marie R, El-Sayed GAK, Attia FM, Gomaa AHA. Evaluation of serum cardiac troponin I and N-terminal pro-B-type natriuretic peptide levels in patients with alopecia areata. Clin Exp Dermatol 2020; 46:153-156. [PMID: 32810890 DOI: 10.1111/ced.14425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
Alopecia areata (AA) is a recurrent, immune-mediated, hair-loss disorder. It is associated with other autoimmune disorders that carry a high risk of cardiovascular disease (CVD). However, there is a lack of reports on the association of cardiovascular comorbidities and AA. Cardiac troponin I is a biomarker of myocardial ischaemia and inflammation, while N-terminal pro-B-type natriuretic peptide is used in the diagnosis of congestive heart failure. This study was conducted to assess the serum level of both markers by ELISA in 44 patients with AA compared with 44 healthy controls (HCs). None of the participants had CVD, CVD risk factors or other diseases associated with elevation of either marker. The study revealed that serum levels of both markers were significantly higher in patients with AA compared with HCs (P < 0.001). The inflammatory milieu encountered in AA may be associated with subtle myocardial inflammation that causes elevation of levels of both of these cardiac markers.
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Affiliation(s)
- R El-Sayed Mahmoud Marie
- Departments of, Department of, Dermatology, Venereology and Andrology, Suez Canal University, Ismailia, Egypt
| | - G A K El-Sayed
- Department of Dermatology, Ministry of Health and Population, Al Hud Al Marsoud Dermatology Hospital, Cairo, Egypt
| | - F M Attia
- Department of, Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - A H A Gomaa
- Departments of, Department of, Dermatology, Venereology and Andrology, Suez Canal University, Ismailia, Egypt
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24
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Wang F, Wu X, Hu SY, Wu YW, Ding Y, Ye LZ, Hui J. Type 2 myocardial infarction among critically ill elderly patients in the Intensive Care Unit: the clinical features and in-hospital prognosis. Aging Clin Exp Res 2020; 32:1801-1807. [PMID: 31598913 DOI: 10.1007/s40520-019-01369-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Type 2 myocardial infarction (T2MI) refers to myocardial ischemic necrosis as a result of myocardial oxygen supply/demand mismatch, which are common comorbidities of critically ill patients. The purpose of this study was to investigate the incidence rate and risks of T2MI in critically ill elderly patients and further elucidate in-hospital prognostic factors. METHODS A total of 223 critically ill elderly patients admitted to our hospital from October 2016 to September 2018 were recruited. The clinical data and the in-hospital mortality rate were compared between the T2MI and non-T2MI groups. Multivariate linear regression analysis was used to identify independent factors related to T2MI. The clinical data and incidence of T2MI were also compared between patients who survived and those who died; multivariate regression analysis was used to identify independent risk factors for in-hospital death and survival analysis was conducted. RESULTS In this study, the incidence of T2MI was 24.2% (54/223), and the mortality rate of critically ill elderly patients was 39.0% (87/223). Multivariate linear regression analysis showed that severe hypoxemia, arrhythmia, shock, and multiple organ dysfunction syndrome (MODS) were independent risk factors of T2MI. Compared to the survival patients, the use of mechanical ventilation, the incidence of T2MI, APACHE II score, troponin T, high-sensitivity C-reactive protein, and procalcitonin levels were significantly higher in patients who died, while the estimated glomerular filtration rate (eGFR) was significantly decreased (all P < 0.05). In-hospital mortality was significantly increased in patients with T2MI (59.3% vs. 32.5%, P < 0.001). After adjustment for relevant factors, the incidence of T2MI, mechanical ventilation required, and eGFR reduction were independent and significant predictors of in-hospital death. CONCLUSIONS Critically, ill elderly patients have a high incidence of T2MI. In addition to severe hypoxia, shock, and arrhythmia, MODS is also associated with T2MI. At the same time, the risk of in-hospital death is increased in patients with type 2 MI.
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25
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Myocardial Injury in Critically Ill Patients with Community-acquired Pneumonia. A Cohort Study. Ann Am Thorac Soc 2020; 16:606-612. [PMID: 30521759 DOI: 10.1513/annalsats.201804-286oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rationale: Myocardial injury, as reflected by elevated cardiac troponin levels in plasma, is common in patients with community-acquired pneumonia (CAP), but its temporal dynamics and etiology remain unknown. Objectives: Our aim was to determine the incidence of troponin release in patients with CAP and identify risk factors that may point to underlying etiologic mechanisms. Methods: We included consecutive patients admitted with severe CAP to two intensive care units in the Netherlands between 2011 and 2015. High-sensitivity cardiac troponin I was measured daily during the first week. We used multivariable linear regression to identify variables associated with troponin release on admission, and we used mixed-effects regression to model the daily rise and fall of troponin levels over time. Results: Of 200 eligible patients, 179 were included, yielding 792 observation days. A total of 152 (85%) patients developed raised troponin levels greater than 26 ng/L. Baseline factors independently associated with troponin release included coronary artery disease (176% increase; 95% confidence interval [CI], 11-589), smoking (248% increase; 95% CI, 33-809), and higher Acute Physiology and Chronic Health Evaluation IV score (2% increase; 95% CI, 0.8-3.3), whereas Staphylococcus aureus as a causative pathogen was protective (70% reduction; 95% CI, 18-89). Time-dependent risk factors independently associated with daily increase in troponin concentrations included reduced platelet count (2.3% increase; 95% CI, 0.6-4), tachycardia (1.5% increase; 95% CI, 0.1-2.9), hypotension (6.2% increase; 95% CI, 2.1-10.6), dobutamine use (44% increase; 95% CI, 12-85), prothrombin time (8.2% increase; 95% CI, 0.2-16.9), white cell count (1.7% increase; 95% CI, 0-3.5), and fever (22.7% increase; 95% CI, 0.1-49.6). Conclusions: Cardiac injury develops in a majority of patients with severe CAP. Myocardial oxygen supply-demand mismatch and activated inflammation/coagulation are associated with this injury. Clinical trial registered with www.clinicaltrials.gov (NCT01905033).
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26
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Šimić S, Svaguša T, Prkačin I, Bulum T. Relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. J Diabetes Metab Disord 2019; 18:693-704. [PMID: 31890693 PMCID: PMC6915172 DOI: 10.1007/s40200-019-00460-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Diabetes mellitus is a group of metabolic disorders associated with high risk for cardiovascular disease. Although troponins are primarily clinically used for the diagnosis of acute coronary syndrome, they are also used in risk assessment in patients with acute coronary syndrome as well as in a number of other conditions. The aim of this review was to investigate the relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. METHODS Hemoglobin A1c has been chosen as the best clinical indicator of glucose control and risk of micro and macrovascular complications. We investigated cardiac troponins as a group of markers of muscle injury which includes troponin T, troponin I and troponin C. Troponin T and I are specific for myocardial injury, compared to C which is specific for skeletal muscle. RESULTS In this review, we showed that there was a causal relation between hemoglobin A1c levels and serum troponin concentrations. Hemoglobin A1c has shown to be a positive predictive factor of incidence, mortality and morbidity of conditions such as acute coronary syndrome, arrhythmias, stroke, pulmonary embolism and other conditions that causes troponin elevation by its release in circulation. CONCLUSIONS Chronic hyperglycemia decreases glomerular filtration and consequently decreases troponin elimination and also by affecting the heart microcirculation it leads to microvascular damage and consequently to ischemia which contribute to troponin concentration elevation. Furthermore, correlation between hemoglobin A1c and troponin concentration manifests in their prognostic value for mortality.
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Affiliation(s)
- Stjepan Šimić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Tomo Svaguša
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
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27
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Niederdöckl J, Simon A, Schnaubelt S, Schuetz N, Laggner R, Sulzgruber P, Spiel AO, Herkner H, Laggner AN, Domanovits H. Cardiac biomarkers predict mortality in emergency patients presenting with atrial fibrillation. Heart 2018; 105:482-488. [PMID: 30415208 PMCID: PMC6580776 DOI: 10.1136/heartjnl-2018-313145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 08/21/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives To assess the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) serum levels for mid-term mortality in patients presenting with symptomatic atrial fibrillation (AF) to an emergency department. Methods Non-interventional cohort/follow-up study, including consecutive patients presenting to a tertiary care university emergency department due to symptomatic AF between 2012 and 2016. Multivariable Cox proportional hazard regression models were used to estimate the mortality rates and hazards per 100 patient-years (pry) for NT-proBNP and hs-TnT serum levels in quintiles. Results 2574 episodes of 1754 patients (age 68 (IQR 58–75) years, female gender 1199 (44%), CHA2DS2-VASc 3 (IQR 1–4)) were recorded. Following the exclusion of incomplete datasets, 1780 episodes were available for analysis. 162 patients deceased during the mid-term follow-up (median 23 (IQR 4–38) months); the mortality rate was 4.72/100 pry. Hazard for death increased with every quintile of NT-proBNP by 1.53 (HR; 95% CI 1.27 to 1.83; p<0.001) and by 1.31 (HR; 95% CI 1.10 to 1.55; p=0.002) with every quintile of hs-TnT in multivariate Cox-regression analysis. No interaction between NT-proBNP and hs-TnT levels could be observed. Conclusion Elevated NT-proBNP and hs-TnT levels are independently associated with increased mid-term mortality in patients presenting to an emergency department due to symptomatic AF. Trial registration number NCT03272620; Results.
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Affiliation(s)
- Jan Niederdöckl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Simon
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Nikola Schuetz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Roberta Laggner
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Alexander O Spiel
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Anton N Laggner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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28
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Berger M, Emir M, Brünnler T, Rockmann F, Lehmann R. Non-coronary predictors of elevated high-sensitive cardiac troponin T (hs-cTnT) levels in an unselected emergency patient cohort. Clin Cardiol 2018; 41:1055-1061. [PMID: 30019381 DOI: 10.1002/clc.23026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/26/2018] [Accepted: 07/07/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Aim of this study was to evaluate the predictors of hs-cTnT in a non-ACS patient cohort admitted to the emergency department. HYPOTHESIS Atrial fibrillation and hypertension may not always be sufficient for elevation for hs-cTnT. METHODS We performed a retrospective, single center study encompassing in total 1003 patients. Individuals were retrospectively divided in ACS- and non-ACS patients by two independent investigators reviewing the medical records. In order to identify predictors of hs-cTnT elevation hazard ratios were calculated for age, gender, vital signs, cardiovascular risk factors, LVEF, serum levels of CRP, hemoglobin, and creatinine. Elevation of hs-cTnT was defined by exceeding 14 ng/L (upper reference limit [URL]). RESULTS About 987 patients were included while 25 patients were excluded because of missing data. 307 patients (31.4%) met the current guideline requirements of diagnosing an ACS, whereas 671 patients (68.6%) were hospitalized with excluded ACS. In the multivariate analysis age, anemia, CRP, creatinine, and reduced systolic left ventricular ejection fraction were independent predictors of elevated troponin T levels in the non-ACS group. However, hypertensive systolic blood pressure, atrial fibrillation and tachycardia were not predictive for Troponin T elevation in non-ACS patients in this multivariate analysis. CONCLUSIONS In an unselected, non-ACS patient cohort age, chronic renal failure, inflammatory state, and reduced left ventricular systolic function were associated with hs-cTnT levels above the upper reference limit. Rather, often supposed predictors as atrial fibrillation, hypertension, and tachycardia cannot sufficiently explain increased hs-cTnT in our study. Hence, further studies are needed to assess whether isolated hypertension, tachycardia, or atrial fibrillation sufficiently explain elevated hs-cTnT.
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Affiliation(s)
- Manfred Berger
- Department of Cardiology, Hospital Barmherzige Brueder, Regensburg, Germany
| | - Meryem Emir
- Department of Cardiology, Hospital Barmherzige Brueder, Regensburg, Germany
| | - Tanja Brünnler
- Emergency Department, Hospital Barmherzige Brueder, Regensburg, Germany
| | - Felix Rockmann
- Emergency Department, Hospital Barmherzige Brueder, Regensburg, Germany
| | - Ralf Lehmann
- Department of Cardiology, Hospital Barmherzige Brueder, Regensburg, Germany
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Bobillo-Perez S, Rodríguez-Fanjul J, Jordan Garcia I. Is Procalcitonin Useful in Pediatric Critical Care Patients? Biomark Insights 2018; 13:1177271918792244. [PMID: 30093797 PMCID: PMC6081751 DOI: 10.1177/1177271918792244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022] Open
Abstract
This review examines the use of procalcitonin in different clinical situations in the pediatric patient, with special emphasis on those requiring intensive care. We review the latest articles on its potency as a biomarker in both infectious processes at diagnosis and on the response to treatment.
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Affiliation(s)
- Sara Bobillo-Perez
- Pediatric Intensive Care Unit Service, Research Group of the Pediatric Critical Patient, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan Garcia
- Pediatric Intensive Care Unit, Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, CIBERESP, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
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Ehrman RR, Sullivan AN, Favot MJ, Sherwin RL, Reynolds CA, Abidov A, Levy PD. Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:112. [PMID: 29724231 PMCID: PMC5934857 DOI: 10.1186/s13054-018-2043-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/16/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sepsis is a common condition encountered by emergency and critical care physicians, with significant costs, both economic and human. Myocardial dysfunction in sepsis is a well-recognized but poorly understood phenomenon. There is an extensive body of literature on this subject, yet results are conflicting and no objective definition of septic cardiomyopathy exists, representing a critical knowledge gap. OBJECTIVES In this article, we review the pathophysiology of septic cardiomyopathy, covering the effects of key inflammatory mediators on both the heart and the peripheral vasculature, highlighting the interconnectedness of these two systems. We focus on the extant literature on echocardiographic and laboratory assessment of the heart in sepsis, highlighting gaps therein and suggesting avenues for future research. Implications for treatment are briefly discussed. CONCLUSIONS As a result of conflicting data, echocardiographic measures of left ventricular (systolic or diastolic) or right ventricular function cannot currently provide reliable prognostic information in patients with sepsis. Natriuretic peptides and cardiac troponins are of similarly unclear utility. Heterogeneous classification of illness, treatment variability, and lack of formal diagnostic criteria for septic cardiomyopathy contribute to the conflicting results. Development of formal diagnostic criteria, and use thereof in future studies, may help elucidate the link between cardiac performance and outcomes in patients with sepsis.
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Affiliation(s)
- Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 3R, Detroit, MI, 48201, USA.
| | - Ashley N Sullivan
- Department of Emergency Medicine, Wayne State University School of Medicine, St. John Hospital and Medical Center, 22101 Moross Rd, Detroit, MI, 48236, USA
| | - Mark J Favot
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 3R, Detroit, MI, 48201, USA
| | - Robert L Sherwin
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 3R, Detroit, MI, 48201, USA
| | - Christian A Reynolds
- Department of Emergency Medicine, Cardiovascular Research Institute, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Aiden Abidov
- Division of Cardiology, Wayne State University School of Medicine, John D. Dingell VA Medical Center, 3990 John R. 4 Hudson, Detroit, MI, 48377, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Medical Center/Detroit Receiving Hospital, 4201 St. Antoine, Suite 3R, Detroit, MI, 48201, USA
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Docherty AB, Sim M, Oliveira J, Adlam M, Ostermann M, Walsh TS, Kinsella J, Lone NI. Early troponin I in critical illness and its association with hospital mortality: a cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:216. [PMID: 28814347 PMCID: PMC5559840 DOI: 10.1186/s13054-017-1800-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/20/2017] [Indexed: 12/21/2022]
Abstract
Background Troponin I (TnI) is frequently elevated in critical illness, but its interpretation is unclear. Our primary objectives in this study were to evaluate whether TnI is associated with hospital mortality and if this association persists after adjusting for potential confounders. We also aimed to ascertain whether addition of TnI to the Acute Physiological and Chronic Health Evaluation II (APACHE II) risk prediction model improves its performance in general intensive care unit (ICU) populations. Methods We performed an observational cohort study with independent derivation and validation cohorts in two general level 3 ICU departments in the United Kingdom. The derivation cohort was a 4.5-year cohort (2010–2014) of general ICU index admissions (n = 1349). The validation cohort was used for secondary analysis of a prospective study dataset (2010) (n = 145). The primary exposure was plasma TnI concentration taken within 24 h of ICU admission. The primary outcome was hospital mortality. We performed multivariate regression, adjusting for components of the APACHE II model. We derived the risk prediction score from the multivariable model with TnI. Results Hospital mortality was 37.3% (n = 242) for patients with detectable TnI, compared with 14.6% (n = 102) for patients without detectable TnI. There was a significant univariate association between TnI and hospital mortality (OR per doubling TnI 1.16, 95% CI 1.13–1.20, p < 0.001). This persisted after adjustment for APACHE II model components (TnI OR 1.05, 95% CI 1.01–1.09, p = 0.003). TnI correlated most strongly with the acute physiology score (APS) component of APACHE II (r = 0.39). Addition of TnI to the APACHE II model did not improve discrimination (APACHE II concordance statistic [c-index] 0.835, 95% CI 0.811–0.858; APACHE II + TnI c-index 0.837, 95% CI 0.813–0.860; p = 0.330) or other measures of model performance. Conclusions TnI is an independent predictor of hospital mortality and correlates most highly with the APS component of APACHE II. It does not improve risk prediction. We would not advocate the adoption of routine troponin analysis on admission to ICU, and we recommend that troponin be measured only if clinically indicated. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1800-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annemarie B Docherty
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Royal Infirmary Edinburgh, 2nd Floor Anaesthetics Corridor, Edinburgh, EH16 4SA, UK. .,Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
| | - Malcolm Sim
- Academic Unit of Anaesthesia, Pain & Critical Care, University of Glasgow, Glasgow, UK
| | - Joao Oliveira
- Department of Critical Care, King's College London, Guys and St Thomas' Hospital, London, UK.,Internal Medicine Department, Hospital Jose Joaquim Fernandes, Beja, Portugal
| | - Michael Adlam
- Department of Critical Care, King's College London, Guys and St Thomas' Hospital, London, UK
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guys and St Thomas' Hospital, London, UK
| | - Timothy S Walsh
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Royal Infirmary Edinburgh, 2nd Floor Anaesthetics Corridor, Edinburgh, EH16 4SA, UK.,Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Kinsella
- Academic Unit of Anaesthesia, Pain & Critical Care, University of Glasgow, Glasgow, UK
| | - Nazir I Lone
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Royal Infirmary Edinburgh, 2nd Floor Anaesthetics Corridor, Edinburgh, EH16 4SA, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Brenner M, Wang P. What'S New in SHOCK, June 2017? Shock 2017; 47:661-665. [PMID: 28505019 DOI: 10.1097/shk.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Max Brenner
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, New York
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Haines R, Crichton S, Wilson J, Treacher D, Ostermann M. Cardiac biomarkers are associated with maximum stage of acute kidney injury in critically ill patients: a prospective analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:88. [PMID: 28399905 PMCID: PMC5388994 DOI: 10.1186/s13054-017-1674-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/17/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study aimed to investigate whether cardiac troponin T (cTnT), cardiac troponin I (cTnI) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with acute kidney injury (AKI) and need for acute renal replacement therapy (RRT) in adult patients admitted to the intensive care unit (ICU). METHODS We analysed prospectively collected data for patients admitted to the ICU between June and December 2010 for non-cardiac reasons. The Kidney Disease Improving Global Outcomes creatinine criteria were applied to identify patients with AKI including those who received acute RRT. Severity of illness was determined by the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Serial Organ Failure Assessment (SOFA) score. Regression analyses were performed to assess the association between cTnT, cTnI and NT-proBNP concentrations on the first day of ICU stay, maximum AKI stages and need for acute RRT. Sensitivity analysis was performed in which patients who developed a myocardial infarction during their stay in the ICU were excluded. RESULTS Of 138 patients included, 73 (53%) had AKI and 40 (29%) required acute RRT. Patients with AKI were significantly older, more likely to have sepsis and had higher APACHE II and SOFA scores on admission to the ICU. In univariable analysis, cTnT, cTnI and NT-proBNP were significantly higher in those with AKI requiring acute RRT, but after adjustment for baseline differences in severity of illness, cumulative fluid balance and pre-existing comorbidities, only NT-proBNP remained significantly associated with worst stage of AKI and need for RRT. cTnT and cTnI were independently associated with the odds of any AKI but not with need for RRT. In a sensitivity analysis in which patients who had an acute myocardial infarction while in the ICU were excluded, NT-proBNP remained independently associated with AKI and acute RRT. CONCLUSIONS In critically ill patients admitted to the ICU for non-cardiac reasons, admission NT-proBNP had the strongest independent association with maximum stage of AKI and need for RRT.
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Affiliation(s)
- Ryan Haines
- Department of Critical Care, King's College London, Guy's and St Thomas' Foundation Hospital, London, SE1 7EH, UK
| | - Siobhan Crichton
- Division of Health and Social Care Research, King's College London, London, UK
| | - Jessica Wilson
- Department of Critical Care, King's College London, Guy's and St Thomas' Foundation Hospital, London, SE1 7EH, UK
| | - David Treacher
- Department of Critical Care, King's College London, Guy's and St Thomas' Foundation Hospital, London, SE1 7EH, UK
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' Foundation Hospital, London, SE1 7EH, UK.
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Guo L, Yang Z, Zhi S, Feng Z, Lei C, Zhou Y. Sensitive detection of cardiac troponin T based on superparamagnetic bead-labels using a flexible micro-fluxgate sensor. RSC Adv 2017. [DOI: 10.1039/c7ra10355g] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In this study, we describe an innovative micro-fluxgate immunosensor based on superparamagnetic Dynabeads for the detection of cardiac troponin T (cTnT), an important biomarker for cardiovascular diseases.
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Affiliation(s)
- Lei Guo
- Key Laboratory for Thin Film and Microfabrication of Ministry of Education
- Research Institute of Micro/Nano Science and Technology
- Shanghai JiaoTong University
- Shanghai 200240
- China
| | - Zhen Yang
- School of Physics and Electronic Engineering
- Xinyang Normal University
- Xinyang 464000
- China
| | - Shaotao Zhi
- Key Laboratory for Thin Film and Microfabrication of Ministry of Education
- Research Institute of Micro/Nano Science and Technology
- Shanghai JiaoTong University
- Shanghai 200240
- China
| | - Zhu Feng
- Key Laboratory for Thin Film and Microfabrication of Ministry of Education
- Research Institute of Micro/Nano Science and Technology
- Shanghai JiaoTong University
- Shanghai 200240
- China
| | - Chong Lei
- Key Laboratory for Thin Film and Microfabrication of Ministry of Education
- Research Institute of Micro/Nano Science and Technology
- Shanghai JiaoTong University
- Shanghai 200240
- China
| | - Yong Zhou
- Key Laboratory for Thin Film and Microfabrication of Ministry of Education
- Research Institute of Micro/Nano Science and Technology
- Shanghai JiaoTong University
- Shanghai 200240
- China
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