Introduction: Myocardial dysfunction is a common complication in patients with sepsis.
Cardiac troponins and natriuretic peptides are biomarkers that were previously introduced for
diagnosis and risk stratifi cation in patients with acute coronary syndrome and congestive heart
failure, respectively. However, their prognostic and diagnostic impact in critically ill patients
warrants defi nition.
Materials And Methods: Patients admitted to the intensive care unit (ICU) between January
2009 to January 2010 of a tertiary care center, who fulfi lled the already reported consensus
criteria for septic shock were included in this study.
Results: Sixty-eight patients with septic shock meeting entry criteria were retrospectively
studied. 64.7% patients were found to have positive troponins (Troponin I> 0.05). Twenty-four
(35.29%) patients had troponin I < 0.05 ng/ml and compromised the troponin I negative group.
Th e mean (S.D) serum troponin I value in troponin I ?positive group was 2.55 ? 1.67 ng/ml.
None of the patient had progressive EKG changes.
Clinical Outcomes In Terms Of Troponins:
Th e Troponin I-positive group had higher APACHE II score (30? 6
Vs 22 ? 4.7) on admission. Twenty-eight patients died in the total study and among them twenty
patients (71.42%) had elevated troponin I. Left ventricular dysfunction was more common in
troponin-I positive group (EF= 38 ? 10) than in Troponin I-negative group (EF= 52 ? 6.5). 63.63
% of the patients with elevated Troponin I required mechanical ventilation as compared to 50%
patients with normal Troponin I levels. Th e patients with elevated troponin I levels had longer
MICU stay ( 7.45 vs 5.28 days)
Clinical Outcomes In Term Of Probnp: Among Twenty-eight deaths in this study, 66.66 %
patients had elevated Pro BNP. Left Ventricular dysfunction was more common in patients with
elevated Pro-BNP (EF= 42 ? 8.2 vs EF =52 ? 10). 76.67 % patients who needed mechanical
ventilation had elevated Pro-BNP. Similarly 67.82 % patients on inotropic support had elevated
Pro-BNP. Elevated Pro-BNP was also found to be associated with increase in MICU stay (6.72
vs 4.35 days)
Conclusion: To date, it is unclear whether clinically unrecognized myocardial cell injury
accompanies, causes, or results from this decreased cardiac performance. Th ese fi ndings suggest
that in septic shock, clinically unrecognized myocardial cell injury is a marker of LV dysfunction.
Dr. Aziz is currently working as Internal Medicine resident at Jersey City Medical Center/ Mount Sinai School
of Medicine. In addition to being an outstanding researcher, Dr. Aziz has authored several articles on different
topics of his research and is working right now on many important research projects related to Critical Care
medicine and Cardiology. These articles have also been cited hundreds of times by other researchers in the
fi eld. Dr. Aziz has presented his fi ndings at various medical conferences and published in several internationally
read peer-reviewed journals. In addition to that he is a member of editorial board of several well-recognized
journal. His work has been well recognized both nationally and internationally.
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