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Elevated troponin I
In summary,[link widoczny dla zalogowanych], this study found that troponin I levels in patients with sepsis there is myocardial damage, and the incidence of myocardial injury is very high; troponin I concentration of both timely reflect the severity of early sepsis, but also can prompt adverse outcome. Found in septic patients when clinically elevated levels of troponin I, which should attract enough attention, timely and appropriate treatment. Therefore, in clinical monitoring of sepsis should be timely and dynamically troponin I concentrations in patients.
【Abstract】 Objective determination of cardiac troponin I in patients with sepsis, the changes of cardiac troponin I in patients with sepsis condition for the assessment of the value and efficacy. Septic patients were measured in the time of admission, admission after 3 and 7 days of the troponin I concentration, analysis of different time points with the same point in time APACHEII score, ICU mortality and the correlation between 28 d survival , comparison of different time points elevated troponin I group (cTnI> 0.1ng/ml) and the normal group (cTnI 0.05), but with the ICU mortality and 28 d survival correlated (r = = 0.37, -0.42, P all <0.05). Patient admission, 3 days after admission the first 7 days after admission, troponin I group, ICU mortality was significantly higher than the normal group, the difference was statistically significant (χ2 =- 2.21, respectively, -3.06, - 3.35, P all <0.05); and 28 d survival rate lower than the normal group, the difference was statistically significant (χ2 were =- 2.40, -3.13, -3.78, P all <0.05). Conclusion troponin I determination in patients with sepsis may help clinicians determine the disease early and the prognosis of the disease have a high predictive value.
3 Discussion
Seen from Table 2, patients with troponin I levels on admission and admission APACHE Ⅱ score was positively correlated (r = 0.37, P 0.05), but with the ICU mortality and 28 d survival correlated (r = = 0.37, -0.42, P all <0.05 .)
1.1 General information select from May 2006 to May 2008 in Zhejiang ICU hospital diagnosed 66 cases of sepsis patients. Meet the diagnostic criteria for sepsis. The diagnosis of sepsis to the American College of Chest Physicians and Critical Care Medicine 2001 joint development of diagnostic criteria. 7d exclude the following pre-hospital myocardial injury caused by elevated markers of reasons: The acute coronary syndrome, severe heart failure, heart surgery, external cardiac massage, defibrillation, direct current cardioversion, liver and kidney dysfunction, tumor, or autoimmune diseases. All patients or their families signed the informed consent. 66 cases of sepsis patients, 47 patients were male, 19 females, aged 23 to 95 years, mean age (69.48 ± 16.70) years. Including sepsis in 10 cases, 33 cases of severe sepsis, septic shock 23. According to the time of admission cardiac troponin I, elevated levels of sub-groups (troponin I> 0.1ng/ml) and normal group (troponin I 0.05); but elevated troponin I in patients APECHE Ⅱ score was significantly higher than the normal group, the difference was statistically significant (t = 2.55, P < 0.05).
Measurement of cardiac troponin I in sepsis patients TAN Chengwu, GONG Shijin, YAN Jing, et al. Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China
Sepsis is caused by infection with systemic inflammatory response syndrome, is a common clinical cause of death in critically ill patients, one may develop septic shock and multiple organ dysfunction syndrome ( multiple organ dysfunction syndrome, MODS). Troponin I as a marker of myocardial injury, with a high degree of specificity. Dynamic observation of this study was the change of troponin in patients with sepsis, analyze it for evaluation and prognosis of the disease the significance of assessment, designed to appropriate treatment and prognosis of sepsis evaluation provide a good laboratory indicators. Are reported below.
Guest TM, and Kollef et al [10,11] found that critically ill patients with positive troponin I than patients with normal troponin I have a higher hospital mortality, but the troponin I rise not independent risk factors for hospital mortality. The same result with the previous studies is that the results of this study found that both the time of admission to the hospital 3 days after the first 7 days, troponin I elevated group than in normal group were significantly higher ICU mortality (P all <0.05 ), and 28 d survival rate was significantly lower than the normal troponin group (P all <0.05), and elevated troponin I continued longer, the higher ICU mortality, 28d, the lower the survival rate. In addition, this study also found that mortality in patients with ICU admission, hospital admission after 3 days and 7 days after the concentration of troponin I was weak positive correlation (P all <0.05), while 28d survival in patients with troponin I and the three time points the concentration was negatively correlated (P all <0.05). Can explain in terms of early disease in patients with sepsis or the development of the disease process, the concentration of troponin I level have a direct impact on patient survival rate of ICU mortality and 28 d, measured in septic patients as soon as possible troponin I, time found in patients with myocardial injury and early treatment measures taken to reduce the mortality of ICU patients, improve the survival rate.
Abstract Objective To investigate cardiac troponin Ⅰ changes in sepsis patients, and analyze its value on severity criterion and prognosis. Methods Sepsis patients who had been admitted into the intensive care unit were studied. Cardiac troponin Ⅰ were measured on admission, the 3rd day and the 7th day after admission. The APACHE II scores were recorded simultaneously. The correlations of cardiac troponin Ⅰ, APACHE II score,[link widoczny dla zalogowanych], ICU mortality, and 28-days survival rate were evaluated. The ICU mortality and 28-days survival rate between the elevated group (cTnI> 0.1ng/ml) and the normal group (cTnI 0.05). But it was correlative with the ICU mortality and the 28-days survival rate (r = 0.37, -0.42, P <0.05). The mortality were higher in elevated group than that in normal group on admission, the 3rd day and the 7th day (χ2 =- 2.21, -3.06, -3.35, P <0.05). The 28-days survival rate was worse in elevated group than that in normal group on admission, the 3rd day and the 7th day (χ2 =- 2.40, -3.13, -3.78, P <0.05). Conclusion Serial measurement of troponin I is a useful marker for severity criterion and prognosis of sepsis patients.
Results may be due to septic patients in this study, the concentration of troponin I have been far less than 1 day and 3 days, it is only one aspect of APACHE Ⅱ scores , not used to judge the condition of the patient. Therefore, recovery of myocardial injury, other functions should be comprehensive evaluation to fully determine the function of organs of the patient's condition. The study suggests that continuous monitoring of blood concentrations of troponin I can not only help clinicians to determine myocardial injury in patients with sepsis complicated, you can also help evaluate the disease early in sepsis, timely and appropriate treatment ( such as cardiac nutrition, anti-inflammatory media, etc.) measures to block the development of sepsis, myocardial cell damage, in order to achieve the purpose of improving the prognosis.
1.2 Methods on admission to the hospital 3 days and serum samples were collected 7 days, respectively, were determined by ELISA in blood concentrations of troponin I, and at the same time point were recorded APECHE Ⅱ score, observed ICU mortality rate (different time and different groups throughout the course of stay in ICU patients with sepsis after the proportion of deaths) and 28 d survival (in different groups of patients with sepsis 28d still the proportion of the number of survivors). Analysis of troponin I levels and in different time APECHE Ⅱ score, ICU mortality and 28 d survival relevance. Troponin I at different time points compared with the control group increased ICU mortality and 28d survival.
Troponin I as a marker of myocardial injury, has been used in clinical practice for many years. Because of its high sensitivity, specificity, and diagnostic window period a long time, clinicians at home and abroad has become a specific marker for diagnosis of myocardial infarction. The results show that in addition found in myocardial infarction myocardial injury, but also found in acute pericarditis,[link widoczny dla zalogowanych], myocarditis, pulmonary embolism, severe heart failure and kidney failure and other diseases [1 ~ 5]. In recent years,[link widoczny dla zalogowanych], the existence of myocardial injury in patients with sepsis in critically ill patients in the field is causing great concern to doctors. Myocardial injury in sepsis could be several reasons: ① a large number of cytokines and the release of reactive oxygen species can cause direct injury of myocardial cells; ② is a bacterial infection, endotoxin toxicity of the cardiac muscle cells; addition pus thyrotoxicosis often occurs microcirculation, microcirculatory disturbances can lead to myocardial ischemia and reperfusion injury [6]. And if the patient has associated with coronary artery disease based on the high fever, hypoxia and other stress conditions, a higher incidence of myocardial injury. Ammann et al [7] found that 85% of the troponin I concentration in patients with sepsis. Troponin I concentration in the 0.17 ~ 15.4ng/ml, with an average 0.57ng/ml, the study in patients with septic shock 40%. Elst et al [8] also found that 50% of patients with early septic shock, cardiac troponin I concentrations higher than 0.4ng/ml, mean 1.4ng/ml. In severe sepsis, septic shock or hypotension, shock patients, 74% of patients with troponin I increase. The study found that almost all patients with hypotension, shock and 58% of severe sepsis or septic shock were troponin I increase. Sepsis, the high incidence of myocardial injury in this study once again confirmed, this study found that the incidence of myocardial injury in patients with sepsis rate of 71.21%, elevated concentrations of troponin I in 0.11 ~ 9.50ng / ml, the average (0.78 ± 0.21) ng / ml. Higher than the relevant reports. The study, severe sepsis and septic shock account for 83% of patients, myocardial damage which may be the main reason for high rates.
2.1 myocardial injury in patients with sepsis results in 66 cases of sepsis patients, 47 patients with elevated troponin I, the incidence of myocardial injury as high as 71.21%, occurred in patients with myocardial injury troponin I concentration in the 0.11 ~ 9.50ng/ml, the average (0.78 ± 0.21) ng / ml.
2.3 group and the normal group APECHE Ⅱ score, ICU mortality and 28d compare the survival rate in Table 3
Troponin I in patients with sepsis,[link widoczny dla zalogowanych], the significance of dynamic monitoring


<div style=\ Of: Tan Kim Cheng Shi Yan Jing Gong E Xu Qiang Wang Dai Haiwen
1 Materials and Methods

2.2 Troponin I in patients with sepsis at different time points and APECHE Ⅱ score, ICU mortality and survival rate in comparison 28d shown in Table 2
1.3 statistical software SPSS11.5 statistical methods used for statistical analysis. Measurement data were mean ± standard deviation (x +-s), said the number of groups were compared using a group t test; count data using chi-square test. To determine the linear correlation relationship among the parameters. Let P <0.05 was considered statistically significant.
2 results
Key words Sepsis; troponin I; prognosis
Table 3 shows, patients either on admission to the hospital 3 days after the first 7 days after admission, troponin I increased ICU mortality group than normal group, the differences were statistically significant (χ2 were =- 2.21, -3.06, -3.35, P all <0.05); the survival rate lower than 28d group, the difference was statistically significant (χ2 =- 2.40, respectively, -3.13, -3.78 , P all <0.05).
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