Chest
Clinical Investigations in Critical CareSerum Cardiac Troponin T as a Prognostic Marker in Early Sepsis
Section snippets
Subjects
Twenty-six patients with sepsis in the ICU were included in this institutionally approved study. It was carried out from 1993 to 1995, according to the criteria of sepsis of the American College of Chest Physicians Consensus Conference,16 having obtained the relatives' informed consent. APACHE (acute physiology and chronic health evaluation) III17 and MOF18 scores were recorded.
Patients were assigned a priori to two groups: (1) with pathologically elevated S-TnT levels (≥0.2 μg/L), and (2) with
RESULTS
Eighteen patients had pathologically elevated S-TnT values, and 8 patients normal S-TnT values. Basic patient characteristics and causes of sepsis (Table 1, Table 2) did not differ significantly between both of these groups. All patients were operated on prior to sepsis. The period between surgery and the onset of sepsis was a median of 5 days (range, 0 to 20 days) for the high S-TnT group and 2 days (range, 1 to 6 days; p=0.334) for the low S-TnT group. Elevated levels of S-TnT were associated
DISCUSSION
The most important result of this study was that elevated S-TnT values were found in patients with sepsis (69%) and this was associated with a higher mortality rate. In 16 of 26 patients, a rise in S-TnT level indicated a poor prognostic outcome. Due to the higher frequency of nonsurvivors in the high S-TnT group, the length of the ICU stay did not differ between groups.
Inadequate myocardial performance is reported to be an important factor contributing to the high mortality in patients with
ACKNOWLEDGMENT
We would like to extend our thanks to A. Schoenknecht (Laboratory of the Department of Clinical Medicine) for her help with the determination of S-TnT and CK-MB and M. Kaynar (Laboratory of the Department of Anesthesiology and Operative Intensive Care Medicine) for her help with the determination of the adhesion molecules.
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Materially supported in part by Boehringer Mannheim Inc, Germany.