Cruz BHJ, Gaytán GCJ, Aguirre SJS, Martínez DBA

Language: Spanish
References: 5
Page: 198-202
PDF size: 220.35 Kb.

ABSTRACT

Introduction: septic shock is one of the most frequent causes of admission to the intensive care unit. It is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Mortality from septic shock ranges from 15 to 30%. The immune response to infectious agents can trigger a cytokine cascade, leading to cell damage, organ failure, and coagulopathy, which correlates significantly with patient prognosis. Hypotension and tachycardia due to cardiovascular disturbances, increased serum levels of the N-terminal prohormone brain natriuretic peptide (NT pro-BNP), troponins, and D-dimer may occur during deterioration in patients with myocardial depression and are often associated with poor prognosis. Objective: to determine the prognostic utility of early determination (< 24 hours) of troponin I, D-dimer and pro-BNP to predict death in patients with septic shock. Material and methods: a simple cohort study was carried out with 65 patients admitted to the Intensive Care Unit of the ABC Medical Center with sepsis criteria according to the 3rd definition and older than 18 years. Patients were excluded from the study if they had a history of myocardial infarction, angina pectoris, coronary angioplasty, pulmonary embolism, or chronic renal failure. Demographic and clinical variables were determined in all cases. Troponin, D-dimer and pro-BNP were determined in the first 24 hours after admission. Continuous variables were expressed as the mean or median. Categorical variables were expressed as frequency and percentage. A ROC curve was performed to find a cut-off point for troponin and pro-BNP and D-dimer values. ORs were determined for the outcomes with their respective confidence intervals. The outcome variable was death. Results: sixty-five patients with septic shock were added to the study. Thirty (46%) patients had elevated serum troponin I. Mortality was 33% versus 26% compared to patients with normal troponin I. A ROC curve was performed to find a cut-off point with troponin values of 50 ng/dL with a sensitivity of 73% to predict death. ORs for troponin outcomes were determined with an OR of 6.6 for death with 95% CI (1.24-34.9). Conclusion: the determination in the first 24 hours of pro-BNP and D-dimer showed no association with mortality for septic shock. Troponin values are a poor predictor of death in patients with septic shock. An elevated troponin value during the first days of admission can be a reliable test to identify patients with a high risk of mortality and risk of myocardial or organic dysfunction. These patients should be selected for more aggressive management.

REFERENCES

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