Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on child...Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin Ⅰ,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin Ⅰ levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin Ⅰ levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.展开更多
BACKGROUND:Patients with suspected acute coronary syndrome (ACS) in whom myocardial infarction has been ruled out are still at risk of having obstructive coronary artery disease (CAD).This rate is higher among patient...BACKGROUND:Patients with suspected acute coronary syndrome (ACS) in whom myocardial infarction has been ruled out are still at risk of having obstructive coronary artery disease (CAD).This rate is higher among patients with intermediate high-sensitivity troponin I (hsTnI) concentrations (5 ng/L to 99th percentile) than low concentrations (<5 ng/L).Therefore,an intermediate concentration has been suggested as a candidate for downstream investigation with computed tomography coronary angiography(CTCA).We tried to compare the HEART score-guided vs.hsTnI-guided approach for identifying obstructive CAD.METHODS:From a prospective cohort study of patients presenting to the emergency department with suspected ACS,433 patients without elevated hsTnI who also underwent CTCA were selected and analyzed.The performances of hsTnI concentration and HEART score were compared using sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV).RESULTS:Overall,120 (27.7%) patients had obstructive CAD.Patients with intermediate hsTnI concentrations were more likely to have obstructive CAD than those with low hsTnI concentrations(40.0%vs.18.1%);patients with non-low-risk HEART scores (≥4 points) were also more likely to have obstructive CAD than those with low-risk scores (0 to 3 points)(41.0%vs.7.6%).The HEART score had higher sensitivity and NPV for detecting obstructive CAD in each classification than hsTnI concentration (sensitivity:89.2%vs.63.3%;NPV:92.4%vs.81.9%,respectively).CONCLUSION:After excluding myocardial infarction in patients with suspected ACS,adding the HEART score for selecting candidates for CTCA could improve patient risk stratification more accurately than relying on hsTnI concentration.展开更多
BACKGROUND There are indications that viral myocarditis,demand ischemia,and renin-angio-tensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019(COVID-19)pati...BACKGROUND There are indications that viral myocarditis,demand ischemia,and renin-angio-tensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019(COVID-19)patients.Antiviral medications and steroids are used to treat viral myocarditis,but their effect in patients with elevated troponin,possibly from myocarditis,has not been studied.AIM To evaluate the effect of dexamethasone,remdesivir,and angiotensin-converting enzyme(ACE)inhibitors(ACEI)on mortality in COVID-19 patients with elevated troponin.METHODS Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California,United States.We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population.Additionally,we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin,comparing survival in patients that received dexamethasone,remdesivir,and ACEI with those that did not.RESULTS The mean age was 66 years(range 20-110),troponin elevation was noted in 11.5%of the patients,and 29.9%expired.The patients'age[hazard ratio(HR)=1.02,P<0.001],intensive care unit admission(HR=5.07,P<0.001),and ventilator use(HR=0.68,P=0.02)were significantly associated with mortality.In the subset of patients with elevated troponin,there was no statistically significant difference in survival in those that received remdesivir(0.07),dexamethasone(P=0.63),or ACEI(P=0.8)and those that did not.CONCLUSION Although elevated troponin in COVID-19 patients has been associated with viral myocarditis and ACE II receptors,conventional viral myocarditis treatment,including antiviral and steroids,and ACEI did not show any effect on mortality in these patients.展开更多
Introduction: Pulmonary embolism is a diagnostic and therapeutic emergency that can be life-threatening. Its mortality is largely attributable to severe forms classically defined by clinical and morphological criteria...Introduction: Pulmonary embolism is a diagnostic and therapeutic emergency that can be life-threatening. Its mortality is largely attributable to severe forms classically defined by clinical and morphological criteria. The aim of this study is to establish the role of two cardiac biomarkers (NT-proBNP and troponin) in assessing the severity of pulmonary embolism. Patients and Methods: We conducted a descriptive and analytical cross-sectional study. Data collection was retrospective over the period from January 1, 2011 to December 31, 2021. All patients hospitalized for pulmonary embolism in two cardiology referral clinics in Cotonou (Atinkanmey Polyclinic and CICA Clinic) were included. Results: The hospital prevalence of pulmonary embolism was 9.08%. The mean age was 52.6 years, with extremes of 18 and 92 years. The sex ratio was 0.73. Pulmonary embolism was severe according to hemodynamic, morphological and sPESI criteria in 12%, 24% and 39% of cases respectively, and mortality was 61.53%. Mean NT-ProBNP and troponin I levels were significantly higher in patients with severe criteria than in those without. NT-proBNP and troponin had good specificity for predicting cardiovascular arrest (99% and 90%), shock (100% and 98%), and hypotension (99% and 96%). NT-proBNP has the best positive predictive values in relation to the occurrence of shock (100%) and right ventricular dilatation (93%). The best correlation coefficient was obtained between right ventricular dilatation and NT-proBNP (0.78). Conclusion: NT-proBNP and troponin I are good biomarkers for predicting the severity of pulmonary embolism and allowing therapeutic adaptation when they are elevated.展开更多
文摘Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin Ⅰ,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin Ⅰ levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin Ⅰ levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.
文摘BACKGROUND:Patients with suspected acute coronary syndrome (ACS) in whom myocardial infarction has been ruled out are still at risk of having obstructive coronary artery disease (CAD).This rate is higher among patients with intermediate high-sensitivity troponin I (hsTnI) concentrations (5 ng/L to 99th percentile) than low concentrations (<5 ng/L).Therefore,an intermediate concentration has been suggested as a candidate for downstream investigation with computed tomography coronary angiography(CTCA).We tried to compare the HEART score-guided vs.hsTnI-guided approach for identifying obstructive CAD.METHODS:From a prospective cohort study of patients presenting to the emergency department with suspected ACS,433 patients without elevated hsTnI who also underwent CTCA were selected and analyzed.The performances of hsTnI concentration and HEART score were compared using sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV).RESULTS:Overall,120 (27.7%) patients had obstructive CAD.Patients with intermediate hsTnI concentrations were more likely to have obstructive CAD than those with low hsTnI concentrations(40.0%vs.18.1%);patients with non-low-risk HEART scores (≥4 points) were also more likely to have obstructive CAD than those with low-risk scores (0 to 3 points)(41.0%vs.7.6%).The HEART score had higher sensitivity and NPV for detecting obstructive CAD in each classification than hsTnI concentration (sensitivity:89.2%vs.63.3%;NPV:92.4%vs.81.9%,respectively).CONCLUSION:After excluding myocardial infarction in patients with suspected ACS,adding the HEART score for selecting candidates for CTCA could improve patient risk stratification more accurately than relying on hsTnI concentration.
文摘BACKGROUND There are indications that viral myocarditis,demand ischemia,and renin-angio-tensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019(COVID-19)patients.Antiviral medications and steroids are used to treat viral myocarditis,but their effect in patients with elevated troponin,possibly from myocarditis,has not been studied.AIM To evaluate the effect of dexamethasone,remdesivir,and angiotensin-converting enzyme(ACE)inhibitors(ACEI)on mortality in COVID-19 patients with elevated troponin.METHODS Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California,United States.We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population.Additionally,we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin,comparing survival in patients that received dexamethasone,remdesivir,and ACEI with those that did not.RESULTS The mean age was 66 years(range 20-110),troponin elevation was noted in 11.5%of the patients,and 29.9%expired.The patients'age[hazard ratio(HR)=1.02,P<0.001],intensive care unit admission(HR=5.07,P<0.001),and ventilator use(HR=0.68,P=0.02)were significantly associated with mortality.In the subset of patients with elevated troponin,there was no statistically significant difference in survival in those that received remdesivir(0.07),dexamethasone(P=0.63),or ACEI(P=0.8)and those that did not.CONCLUSION Although elevated troponin in COVID-19 patients has been associated with viral myocarditis and ACE II receptors,conventional viral myocarditis treatment,including antiviral and steroids,and ACEI did not show any effect on mortality in these patients.
文摘Introduction: Pulmonary embolism is a diagnostic and therapeutic emergency that can be life-threatening. Its mortality is largely attributable to severe forms classically defined by clinical and morphological criteria. The aim of this study is to establish the role of two cardiac biomarkers (NT-proBNP and troponin) in assessing the severity of pulmonary embolism. Patients and Methods: We conducted a descriptive and analytical cross-sectional study. Data collection was retrospective over the period from January 1, 2011 to December 31, 2021. All patients hospitalized for pulmonary embolism in two cardiology referral clinics in Cotonou (Atinkanmey Polyclinic and CICA Clinic) were included. Results: The hospital prevalence of pulmonary embolism was 9.08%. The mean age was 52.6 years, with extremes of 18 and 92 years. The sex ratio was 0.73. Pulmonary embolism was severe according to hemodynamic, morphological and sPESI criteria in 12%, 24% and 39% of cases respectively, and mortality was 61.53%. Mean NT-ProBNP and troponin I levels were significantly higher in patients with severe criteria than in those without. NT-proBNP and troponin had good specificity for predicting cardiovascular arrest (99% and 90%), shock (100% and 98%), and hypotension (99% and 96%). NT-proBNP has the best positive predictive values in relation to the occurrence of shock (100%) and right ventricular dilatation (93%). The best correlation coefficient was obtained between right ventricular dilatation and NT-proBNP (0.78). Conclusion: NT-proBNP and troponin I are good biomarkers for predicting the severity of pulmonary embolism and allowing therapeutic adaptation when they are elevated.
