الفهرس | Only 14 pages are availabe for public view |
Abstract Background: Serum troponin concentrations have been associated with increased mortality in almost every clinical setting they have been examined, including sepsis. Sepsis is the physiological response to severe infection. It is defined as the presence (probable or documented) of infection together with systemic features of inflammation. Severe sepsis is sepsis-induced tissue hypoperfusion or organ dysfunction, and septic shock refers to sepsis-induced hypotension, persisting despite adequate fluid resuscitation, which may be defined as infusion of 30 ml/kg of crystalloids. Elevated troponin levels are observed in 43% across all intensive care patient groups. The estimated prevalence of positive troponin in the context of sepsis is 61%. The mechanism of myocyte insult in severe sepsis and septic shock, in the absence of thrombotic acute coronary syndrome, leading to elevated serum troponin, is not yet fully understood. Myocardial depressive factors (inflammatory mediators, endotoxins), microvascular dysfunction and increased myocardial cell membrane permeability in conjunction with myocardial oxygen demand– supply mismatch, are potential explanations for sepsis induced troponin elevation. In this setting, troponin elevation occurs in the absence of myocytenecrosis and this hypothesis is supported by clinical observations that myocardial depression in the context of sepsis is a reversible process in most surviving patients. The aim of this study is to evaluate the prognostic value of troponin T level at admission and serial troponin T testing in patients with severe sepsis and septic shock. This work was carried on 70 patients with severe sepsis and septic shock from those attending the intensive care units in Ain shams university hospitals in the time period between February 2018 and July 2018. These patients were subdivided into 2 groups each consisted of 35 patients, the first group with elevated troponin T at admission and the other group with negative troponin T at admission. Keywords: Role; Troponin-T; Admission; Serial Troponin-T; Testing; Predicting Outcome; Severe Sepsis; Septic Shock |