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Myocardial cell injury is common in children with septic shock
Rakesh Lodha1, Sasi Arun, Subbiah Vivekanandhan
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. rakesh_lodha@hotmail.com
Insights
Myocardial cell injury is common in children with septic shock, indicated by elevated troponin I (TnI) levels. Higher TnI levels correlate with mortality, aiding in prognostication for pediatric septic shock patients.
Area of Science:
- Pediatric critical care medicine
- Cardiology
- Biochemistry
Background:
- Septic shock in children can lead to myocardial dysfunction.
- Biochemical markers are used to assess cardiac injury.
Purpose of the Study:
- To determine the prevalence of myocardial cell injury in pediatric septic shock.
- To estimate levels of troponin I (TnI) and creatine kinase-MB (CK-MB) as markers of myocardial injury.
Main Methods:
- Children aged 3 months to 16 years with septic shock were studied.
- Control groups included children with sepsis without shock and hypovolemic shock.
- Serum TnI and CK-MB levels were measured at admission and serially (24, 48, 96 hours).
Main Results:
- 88% of children with septic shock showed elevated TnI levels, significantly higher than controls (p < 0.001).
- Serial TnI levels were higher in non-survivors.
- Baseline TnI levels positively correlated with predicted mortality (PIM2 scores).
Conclusions:
- A majority of children experiencing septic shock exhibit signs of myocardial cell injury.
- Serum TnI levels can aid in the prognostication of pediatric septic shock.
Objective:
To determine the prevalence of myocardial cell injury in children with septic shock by estimating the levels of biochemical markers of myocardial injury, troponin I (TnI) and creatine kinase MB (CK-MB).
Patients:
Children aged 3 months to 16 years were admitted to paediatric intensive care unit (PICU) with septic shock. Children with sepsis without shock and children with hypovolaemic shock were enrolled as controls.
Measurements And Main Results:
Serum TnI and CK-MB levels were measured at admission and serially at 24 h, 48 h and 96 h in children with septic shock, while baseline measurement of the same markers was taken from the controls. In total, 88% (15/18) of children with septic shock had elevated TnI levels compared with 25% (5/20) with sepsis and 6.7% (1/15) with hypovolaemic shock (p < 0.001). Serial TnI levels at admission, 24 h, 48 h and 96 h were higher in the nonsurvivors. There was a positive correlation between the baseline TnI levels and the predicted mortality using the paediatric index of mortality (PIM2) scores at admission (r = 0.51, p = 0.03).
Conclusion:
A majority of children with septic shock have evidence of myocardial cell injury. The estimation of serum TnI levels may help in better prognostication of children with septic shock.
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