What Raises Troponins in the Paediatric Population?

Abstract

Troponin I is a cardiac enzyme that is released during myocardial injury. However, cardiac enzymes are non-specific and can occur in many cardiac and non-cardiac pathologies. We aim to (1) describe the range of acute conditions that were associated with raised troponins in the paediatric population in our institution and (2) quantify the extent of troponin elevation and correlate it with the underlying aetiology. We performed a retrospective observational study in a tertiary institution which included patients from 1 January 2009 to 31 December 2013. We identified patients with troponin I levels of more than 0.1 ng/ml who have not had cardiac surgery before. We recorded their final diagnoses, and then compared the peak troponin levels and the eventual final diagnoses. We identified 100 patients. The top few common diagnoses resulting in a raised troponin were sepsis (29%), cardiac pathologies (29%) such as tachyarrhythmias and cardiomyopathies and myocarditis (21%). Other pathologies included trauma and other causes of multiorgan dysfunction. The median peak troponin I was higher in cardiac as compared to non-cardiac pathologies: 2.15 (0.52-15.0) and 0.44 (0.21-1.68), respectively. There was no statistically significant difference in the peak troponin I values in the presence of hypotension or renal impairment. We described the range of conditions that may result in raised troponin I levels. The extent of raised troponin I levels may potentially be useful in differentiating between cardiac and non-cardiac pathologies. However, further studies on a larger scale are required to establish whether extent of troponin I elevation has a diagnostic role for cardiac pathologies.

A Review of Extraintestinal Manifestations & Medication-Induced Myocarditis and Pericarditis in Pediatric Inflammatory Bowel Disease

“…In the current cohort, 50% had elevated erythrocyte sedimentation rate (ESR) (14/28), 39% had elevated c-reactive protein (CRP) (11/28), and 18% had elevated WBC (5/28). Cardiac biomarkers (typically troponin and brain natriuretic peptide (BNP)) were sent to assess for myocardial injury and negative values were useful to help exclude a diagnosis of myocarditis [52].…”

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

“…In earlier studies, in addition to the clinical severity score and hypotensive shock, [12][13][14] the increase in cTnI at admission was associated with decreased cardiac function measured by echocardiography, 12 heart disease, and sepsis. 15 From this perspective, the causes of abnormal cTnI should be investigated and the underlying diseases treated. The striking association between cTnI and serum lactate requires an explanation.…”

“…31 Studies on the role of cTnI as a biomarker of illness severity have focused on different aspects. In some, only a descriptive evaluation of the data was performed 15 ; others analyzed the relationship between cTnI and sepsis and investigated its association with cardiac dysfunction, 12 with mortality and disease severity. [12][13][14] In a cohort in which cTnI was routinely measured on admission to the PICU, the increase in its concentrations was associated with a higher vasoactive-inotrope score.…”

“…13 There are few studies on serum cTnI concentrations as a prognostic marker in pediatric sepsis. [12][13][14][15] Particularly in those where inferential statistical analysis was performed, factors potentially related to outcomes such as serum lactate, 16 nutritional status, 17 and the magnitude of systemic inflammation 18 were not considered in multiple regression models. Furthermore, the samples in these studies included patients with chronic conditions, such as heart disease and chronic kidney disease, which in themselves can affect cTnI concentrations and outcomes.…”