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DOI: 10.1055/s-0034-1543983
Cardiac Troponin Levels in Neonates Who Require ECMO for Noncardiac Indications Are Elevated in Nonsurvivors
Publication History
14 August 2014
18 November 2014
Publication Date:
21 January 2015 (online)
Abstract
Objective The aim of the study is to determine the utility of cardiac troponin (cTnI) as a marker of mortality and morbidity in newborn infants who require extracorporeal membrane oxygenation (ECMO).
Study Design Retrospective medical chart analysis of term or near-term newborn infants treated with ECMO from 2002 to 2012 at a single Level III neonatal intensive care unit. Data analyzed included serial serum cTnI measurements, clinical and demographic characteristics, pre-ECMO laboratory values, and ECMO laboratory values and outcomes.
Results Survival (27/46) was significantly related to birth weight (3,413.9 ± 662.3 vs. 2,667.7 ± 478.3 g, p < 0.001), outborn status (22/30 vs. 5/13, p = 0.0021), and the absence of a congenital diaphragmatic hernia (22/30 vs. 5/18, p = 0.0021). Mean peak cTnI did not differ between survivors and nonsurvivors but when peak cTnI was < 2.8 ng/mL, survival was 64% compared with 22% when it was > 2.8 ng/mL (p = 0.0224; odds ratio = 0.160, 95% confidence interval = 0.0292–0.8778). By multivariate analysis, peak cTnI > 2.1 was a significant risk factor for nonsurvival, p = 0.0497. The area under the curve of a receiver-operator analysis using peak cTnI > 2.1, birth weight, and birthplace was 0.89, p < 0.001.
Conclusion cTnI is an independent biomarker for poor outcome in neonates who receive ECMO therapy for noncardiac generations.
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References
- 1 UK Collaborative ECMO Trail Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet 1996; 348 (9020) 75-82
- 2 Khan AM, Lally KP. The role of extracorporeal membrane oxygenation in the management of infants with congenital diaphragmatic hernia. Semin Perinatol 2005; 29 (2) 118-122
- 3 Hervey-Jumper SL, Annich GM, Yancon AR, Garton HJ, Muraszko KM, Maher CO. Neurological complications of extracorporeal membrane oxygenation in children. J Neurosurg Pediatr 2011; 7 (4) 338-344
- 4 Santiago MJ, Sánchez A, López-Herce J , et al. The use of continuous renal replacement therapy in series with extracorporeal membrane oxygenation. Kidney Int 2009; 76 (12) 1289-1292
- 5 Pettignano R, Cornish JD, Clinical management of neonates on venoarterial ECMO. In: Extracorporeal Cardiopulmonary Support in Critical Care. Zwischenberger JB, Steinhorn RH, Bartlett RH , Eds. 2nd Ed. Ann Arbor MI: Extracorporeal Life Support Organization; 2000: 363-381
- 6 Becker JA, Short BL, Martin GR. Cardiovascular complications adversely affect survival during extracorporeal membrane oxygenation. Crit Care Med 1998; 26 (9) 1582-1586
- 7 Anaya P, Moliterno DJ. The evolving role of cardiac troponin in the evaluation of cardiac disorders. Curr Cardiol Rep 2013; 15 (11) 420
- 8 Correale M, Nunno L, Ieva R , et al. Troponin in newborns and pediatric patients. Cardiovasc Hematol Agents Med Chem 2009; 7 (4) 270-278
- 9 Shastri AT, Samarasekara S, Muniraman H, Clarke P. Cardiac troponin I concentrations in neonates with hypoxic-ischaemic encephalopathy. Acta Paediatr 2012; 101 (1) 26-29
- 10 Mu SC, Wang LJ, Chen YL, Lin MI, Sung TC. Correlation of troponin I with perinatal and neonatal outcomes in neonates with respiratory distress. Pediatr Int 2009; 51 (4) 548-551
- 11 Clark SJ, Newland P, Yoxall CW, Subhedar NV. Concentrations of cardiac troponin T in neonates with and without respiratory distress. Arch Dis Child Fetal Neonatal Ed 2004; 89 (4) F348-F352
- 12 Trevisanuto D, Doglioni N, Altinier S, Zaninotto M, Plebani M, Zanardo V. Cardiac troponin I at birth is of fetal-neonatal origin. Arch Dis Child Fetal Neonatal Ed 2009; 94 (6) F464-F466
- 13 Bhayana V, Henderson AR. Biochemical markers of myocardial damage. Clin Biochem 1995; 28 (1) 1-29
- 14 Hetland O, Dickstein K. Cardiac troponins I and T in patients with suspected acute coronary syndrome: a comparative study in a routine setting. Clin Chem 1998; 44 (7) 1430-1436
- 15 Stevens TP, Chess PR, McConnochie KM , et al. Survival in early- and late-term infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation. Pediatrics 2002; 110 (3) 590-596
- 16 Paden ML, Conrad SA, Rycus PT, Thiagarajan RR ; ELSO Registry. Extracorporeal life support organization report 2012. ASAIO J 2013; 59 (3) 202-210
- 17 Loforte A, Marinelli G, Musumeci F , et al. Extracorporeal membrane oxygenation support in refractory cardiogenic shock: treatment strategies and analysis of risk factors. Artif Organs 2014; 38 (7) E129-E141
- 18 Zhang R, Kofidis T, Kamiya H , et al. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg 2006; 30 (4) 617-620
- 19 Vélez-Martínez M, Ayers C, Mishkin JD , et al. Association of cardiac troponin I with disease severity and outcomes in patients with pulmonary hypertension. Am J Cardiol 2013; 111 (12) 1812-1817
- 20 Heresi GA, Tang WH, Aytekin M, Hammel J, Hazen SL, Dweik RA. Sensitive cardiac troponin I predicts poor outcomes in pulmonary arterial hypertension. Eur Respir J 2012; 39 (4) 939-944
- 21 Cauley RP, Stoffan A, Potanos K , et al; Congenital Diaphragmatic Hernia Study Group. Pulmonary support on day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia. J Pediatr Surg 2013; 48 (6) 1183-1189