P710High-sensitivity cardiac Troponin T is a better predictor for outcome than echocardiography and other markers in patients with SIRS and shock in intensive care.


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Abstract

Purpose: This study investigated the prognostic information of echocardiography, critical illness scores and cardiac biomarkers for longer-term survival in patients with shock.Methods: 49 patients with SIRS and shock were included. Cardiac biomarkers BNP and hsTNT were measured, APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores were calculated and transthoracic echocardiography was performed within 24h of study inclusion. Left ventricular systolic function was assessed by ejection fraction (EF), mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs) and velocity time integral in the LV outflow tract (VTI). LV diastolic function was measured by transmitral pulsed Doppler (E, A, E/A), TDI in the mitral annulus (É, Á, E/É), deceleration time (Dt) and left atrial volume (La). Variables significantly associated with 1 year mortality were analyzed with multivariable logistic regression. Receiver operating characteristic and Kaplan–Meier (KM) curves were generated. Adjusted odds ratio (OR) were calculated.Results: hsTNT (p=0.000), APACHE II (p=0.009), E/É (p=0.023), La (p=0.024), SOFA (p=0.024) and age (p=0.031) were significantly higher in non- survivors. Logistic regression revealed hsTNT as an independent predictor of 1-year mortality (p= 0.011) with an adjusted OR was 2.2 (95% CI 1.2 to 4.1). KM survival curves showed a relationship according to hsTNT quartiles (Fig). Area under the curve for hsTNT was 0.821 (95% CI 0.691- 0.950). For hsTNT (cut off 80ng/l) the adjusted OR was 6.3 (95% CI 1.6 to 25.3 p=0.009).Conclusions: HsTNT was an independent predictor for 1-year mortality in patients with shock. Neither BNP nor systolic echocardiographic parameters were predictive.

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