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Cardiac troponin I is associated with ICU admission in pediatric patients with RSV
Meghan Brown1, Sydney Lawless1, Brittany Roemmich1
1Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology. Washington University in St. Louis, St. Louis, MO, USA.
Insights
Elevated cardiac troponin I (cTnI) levels in pediatric patients with respiratory syncytial virus (RSV) are linked to intensive care unit (ICU) admission and bronchiolitis. This finding may aid in early prognostication and treatment.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Biomarker research
Background:
- Respiratory syncytial virus (RSV) causes significant pediatric morbidity and mortality.
- Limited tools exist for prognosticating RSV outcomes in children.
- Cardiac troponin I (cTnI) was evaluated as a prognostic biomarker.
Purpose of the Study:
- To assess the utility of cTnI in predicting intensive care unit (ICU) length of stay (LOS) and bronchiolitis in pediatric patients with RSV.
- To determine if elevated cTnI levels correlate with severe RSV outcomes.
Main Methods:
- 114 pediatric patients with RSV and 45 controls were enrolled.
- High-sensitivity cTnI was measured in plasma samples.
- Statistical analyses included Fisher's exact test and multivariable logistic regression.
Main Results:
- 56.9% of ICU-admitted RSV patients had cTnI above the limit of detection (LOD), versus 27.0% of non-ICU patients.
- Elevated cTnI was associated with increased odds of ICU admission (OR 2.37) and bronchiolitis (OR 2.78).
- Receiver operator characteristic analysis showed moderate predictive ability for ICU admission (AUC 0.62).
Conclusions:
- Elevated cTnI levels above the LOD are associated with ICU admission and bronchiolitis in pediatric RSV cases.
- cTnI shows potential as a prognostic biomarker for severe RSV outcomes.
- Further research is needed to validate these findings.
Background:
Respiratory syncytial virus (RSV) is associated with morbidity and mortality in pediatric patients, but limited tools exist for prognostication of outcomes that may facilitate more rapid treatment. We assessed the utility of cardiac troponin I (cTnI) to prognosticate intensive care unit (ICU) length of stay (LOS) and bronchiolitis in pediatric patients.
Methods:
Remnant EDTA plasma from 114 patients 6 months-18 years positive for RSV were enrolled. Forty-five patients with other respiratory infections were included as controls. The electronic medical record was assessed for demographic information. High sensitivity cTnI was assessed on an Abbott ARCHITECT i2000 within 24 h of collection. Proportions were compared using Fisher's exact test and multivariable logistic regression performed.
Results:
Of patients admitted to ICU with RSV, 56.9 % had cTnI ≥ the limit of detection (LOD) compared to 27.0 % of patients not admitted to the ICU. Receiver operator characteristic analysis revealed an area of 0.62 (0.53-0.72) for predicting ICU admission. At the limit of quantitation, cTnI had a sensitivity of 25.8 %, a specificity of 88.9 %, and a positive likelihood ratio of 2.32 for ICU admission. Multivariable logistic regression revealed that log2 increases in cTnI (doubling) was associated with an odds ratio (OR) of 1.34 (95 % CI: 1.03-1.78) for ICU admission. cTnI > the LOD was associated with an OR of 2.37 (1.03-5.57) for ICU admission and bronchiolitis (2.78, 1.09-7.83).
Conclusions:
Elevated cTnI above the LOD was associated with ICU admission and bronchiolitis in pediatric patients presenting with RSV. Further studies are needed to verify this finding.
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