Key result
Admission to the paediatric intensive care unit for ventilatory support was associated with significantly higher median cardiac troponin T levels (18 pg/ml) compared to healthy controls (10 pg/ml).
Why the study?
Are cTnT levels elevated in critically ill infants without congenital heart disease admitted to the PICU, and are they associated with increased disease severity?
Case-Control (n=107)
No
Are cTnT levels elevated in critically ill infants without congenital heart disease admitted to the PICU, and are they associated with increased disease severity?
Absolute Event Rate: 18% vs 10%
p-value: p=<0.001
Critically ill infants in the neonatal period have higher cTnT levels compared to older infants, but this elevation does not correlate with disease severity when corrected for age and weight, suggesting cTnT is not a suitable marker of disease severity in neonates on a PICU.
cTnT elevations in ventilated PICU infants without CHD do not correlate with severity after age adjustment; supports limited utility as a severity marker and warrants prospective validation.
INTRODUCTION: Cardiac troponin T (cTnT) has been used to assess prevalence of myocardial injury in critically ill children. The majority of studies investigated patients undergoing cardiac surgery. Myocardial injury has been associated with increased mortality. Our objectives were to investigate whether cTnT levels are elevated in infants without congenital heart disease admitted to the paediatric intensive care unit (PICU) and whether levels are associated with increased disease severity. METHODS: We measured cTnT in consecutive infants (<12 months old) without congenital heart disease admitted to the PICU and healthy infants. The Paediatric Index of Mortality (PIM) score was determined in patients on the PICU. RESULTS: We recruited 107 infants: 47 infants admitted to the PICU and 60 healthy controls. Controls were, with a median (interquartile range (IQR)) age of 20 (12 to 34) weeks, significantly older than cases, with a median age of 6.5 (0.3 to 20.6) weeks. CTnT levels were, with a median (IQR) of 18 (10 to 60) pg/ml, significantly higher in admissions to the PICU than in controls, with a median level of 10 (10 to 10) pg/ml (95th centile of 20 pg/ml) (p < 0.001). There was a significant positive correlation (r = 0.41, p = 0.004) between PIM score and cTnT levels. Admissions under one month old had higher cTnT levels than older patients (p = 0.013) but the PIM score was not significantly different between them. When corrected for age and weight the correlation of PIM and cTnT was no longer significant. CONCLUSION: Infants on the PICU in the neonatal period have higher cTnT levels compared to older infants despite not having more severe disease.
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Clark et al. (2006) conducted a case-control in Critically ill infants requiring ventilatory support (n=107). Admission to paediatric intensive care unit (PICU) for ventilatory support vs. Healthy infants was evaluated on Median cardiac troponin T (cTnT) levels (pg/ml) (p=<0.001). Admission to the paediatric intensive care unit for ventilatory support was associated with significantly higher median cardiac troponin T levels (18 pg/ml) compared to healthy controls (10 pg/ml).
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