Value of Cardiac Enzymes in Early Diagnosis of Cardiac Dysfunction in Pediatric Septic Shock

Purpose: Sepsis induced myocardial dysfunction (SIMD) is a severe complication in pediatric septic shock. The purpose of this study was to study serum cardiac troponin I (cTnI) as a biomarker for early detection of myocardial cell injury in pediatric severe sepsis and septic shock and to investigate its association with ECHO findings and clinical outcomes in pediatric septic shock.

Methods: This study is a case control study that was carried out at Cairo University Children, s Hospital pediatric intensive care units (PICUs) from October 2016 to April 2017. Study included 80 patients whose ages ranged from 3 months to 12 years (40 normal controls coming to the outpatient clinics &40 cases in the PICUs who had clinical signs of severe sepsis and septic shock: 25 males and 15 females with a median age of 18 months). Bedside ECHO was done to the 40 included cases in the PICU to evaluate LV systolic function, LV diastolic function and RV function.

Results: Serum cTnI was elevated in 33 of the 40 included cases (82.5%) and none of the controls showed cTnI elevation (0%). Prevalence of LV systolic dysfunction was 77.5%, LV diastolic dysfunction was 52.5% and RV dysfunction was 52.5%. Serum cTnI was correlated with LV systolic function but not with LV diastolic function, RV function, PRISM score or mortality.

Conclusion: Elevated serum cTnI is highly prevalent in pediatric septic shock and is associated with decreased contractile function of the heart but not with clinical outcomes.