Cardiac troponin: a new serum marker of myocardial injury in sepsis

Fernandes, Constantino José; Akamine, Nelson; Knobel, E

doi:10.1007/s001340051030

Cited by 159 publications

(103 citation statements)

References 10 publications

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“…Both AKI and myocardial dysfunction are also common in sepsis. [70][71][72] Data have found that 30-80% of septic patients have elevated cardiac-specific troponins [73][74][75] Hepato-Renal syndrome…”

Section: Secondary Cardio-renal Syndromes (Type 5 Crs)mentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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Section: Secondary Cardio-renal Syndromes (Type 5 Crs)mentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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“…The mortality from septic shock syndrome ranges from 20% to 90%, depending upon the patient's age and associated pathologies (Wenzel and Edmond, 2001). Using clinical markers for myocardial damage such as cardiac troponin I (cTnI), various research laboratories have suggested that almost 50% of septic patients exhibit myocardial dysfunction in ICUs (Charpentier et al, 2004;Fernandes et al, 1999;Maeder et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Chopra

Sharma

2007

Life Sciences

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We hypothesized that progressive decline in myocardial performance would correlate with upregulation of markers for apoptotic mechanisms following increased duration of polymicrobial sepsis in the rat. Male Sprague-Dawley rats (350-400 g) were randomized into sham, 1-, 3-and 7-day sepsis groups. Each septic rat received 200 mg/kg cecal inoculum intraperitoneally (i.p). The post-mortem analysis showed a severely inflamed peritoneum with the presence of pus in all septic animals that was directly proportional to the duration of sepsis. We observed 10, 33 and 42% mortality in the 1-, 3-and 7-day sepsis groups, respectively. Septic animals at 3 and 7 days exhibited an increased wet lung/total body weight and heart weight/total body weight. A significant increase in total cardiac troponin I (cTnI) and C Reactive Protein (CRP) and endothelin-1 (ET-1) was also observed with an increased duration of sepsis. Myocardial ET-1 concentration in the 7-day postsepsis group was significantly elevated compared to the sham and 1-day post-sepsis groups. Sepsis also produced a significant decrease in the mean arterial pressure in the 7-day post-sepsis group and tachycardia in the 1-, 3-, and 7-day post-sepsis groups compared to the sham group. A significant prolongation of the left ventricular isovolumic relaxation rate constant, tau, and left ventricular enddiastolic pressure in the 1-, 3-and 7-day post-sepsis groups compared to the sham group was observed. In addition, a significant decrease in the rates of left ventricular relaxation (−dP/dt) and contraction (+dP/dt) in the 3-and 7-day post-sepsis groups compared to the sham and 1-day postsepsis group was observed. Sepsis produced a significant upregulation in the expression of myocardial TRADD, cytosolic active caspase-3, the Bax/Bcl 2 ratio, and the mitochondrial release of cytochrome C in the 3-and 7-day post-sepsis groups. We observed a progressive increase in the number of TUNEL positive nuclei, cytosolic caspase-3 activation and co-localization of PARP in the nuclei at 1, 3 and 7 days post-sepsis. These data suggest that the progression of sepsis from 1 day to 3-7 days produce distinct cardiodynamic characteristics with a more profound effect during later stages. The sepsis-induced decline in myocardial performance correlates with the induction of myocardial apoptosis.

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“…12 Of note, multivessel coronary artery disease was more prevalent across progressively higher quartiles of troponin T, suggesting an ischemic mechanism for the troponin increase in this patient population. 13 In heart failure patients, elevated troponin is associated with the risk of death and rehospitalization regardless of underlying cause and the three-year survival is about 29%. 14,15 Critically ill patients who require stay in an intensive care unit are a heterogeneous group of patients who are ill for a variety of heterogeneous diseases.…”

Section: Discussionmentioning

confidence: 99%

Study of troponin-t elevation in critically ill patients-incidence and outcome

et al. 2017

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Background: Besides cardiac disease, critical illness patients are often subjected to myocardial injury. Hence, the goal of present study was to analyze the incidence of elevated cardiac troponin levels in critically ill patients and its outcome which in turn can act as a prognostic marker.Methods: The settings were the ICU’s of a tertiary care hospital in south India. A sample of 54 was identified using purposive sampling technique. Serial monitoring of troponin T was done on day 1, 3 and 5. A performa was used to collect the baseline data of who met the inclusion and exclusion criteria. The collected data was analyzed by using descriptive and inferential statistics.Results: Among 54 patients 17 (31.5%) of them expired. It was found that patients with mean APACHE score were significantly greater among mortality group (P<0.001). When analyzing the outcome in relation to the troponin T levels, it can be concluded that troponin levels were higher among patients who died but it was not statistically significant. (p=0.56, 0.84 and 0.67 on day 1, 3 and 5 respectively). Among the 54 patients it is inferred from the findings that most of the critically ill patients do have high troponin T levels.Conclusions: The study illustrated the incidence of high troponin T levels in critically ill patients which is an informative prognostic indicator. The relation couldn’t be proved due to less sample size and other imposing factors in critically ill such as broad diagnostic categories.

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Cardiac troponin: a new serum marker of myocardial injury in sepsis

Abstract: Identification of myocardial dysfunction in septic patients has been a challenging task. Troponin I, a serum marker of myocardial injury, may be of great help in the recognition of myocardial involvement by sepsis in a noninvasive and readily available way.

Cited by 159 publications

References 10 publications

Review article: Acute kidney injury in critical illness

Review article: Acute kidney injury in critical illness

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Study of troponin-t elevation in critically ill patients-incidence and outcome

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