ABSTRACT
Objetivo: Avaliar a associação da troponina I e da disfunção miocárdica com mortalidade no choque séptico. Métodos: Coorte de 67 pacientes consecutivos com idade acima de 65 anos, no período de 32 meses, tendo diagnóstico de choque séptico com monitoração da artéria pulmonar. O escore APACHE II foi calculado em todos os pacientes. A mensuração da troponina I foi realizada nas primeira 24 horas de internação e quando havia evolução para disfunção miocárdica. A troponina I foi o teste considerada positiva quando o nível sérico apresentava-se acima de 0,5mg/ml. A disfunção miocárdica foi definida pelos critérios de Le Gall et al. Para análise estatística empregou-se o teste do qui-quadrado, o teste 1 e a análise de sobrevida de kaplan-Meier, considerando-se valor inferior a 5 por cento como nível de significância. Resultados: A média da idade foi 80 anos e do APACHE II foi 19. Houve 39 óbitos (58 por cento) e a disfunção miocárdica ocorreu em 46 por cento dos pacientes. A troponina I foi positiva em 22 dos 31 pacientes que evoluíram com disfunção...
Objective: To evaluate the association between troponin I and myocardial dysfunction with mortality in septicshock. Methods: The cohort followed up for 32 months, monitoring the pulmonary arteries of 67 patientsover 65 years old diagnosed with septic shock. APACHE II scoring was calculated for all patients. Troponin I levels were taken in the first 24 hoursafter admission and when myocardial dysfunction occurred. Troponin I was considered positive for serum levels over 0.5ng/ml. Myocardial dysfunction was defined by Le Galls criteria1. Statistical treatment was provided through chisquare test, t test and analysis of the Kaplan- Meier survival curve, with under 5% consideredstatistically significant. Results: The average age was eighty years old and the average APACHE II score was 19. There were 39 deaths (58%), with myocardial dysfunction present in 46% of the patients. Troponin I was positive in 22 out of 31 patients with myocardial dysfunction. Although myocardialdysfunction demonstrated a borderline p-value (p=0.049) when analyzed by the chi-square test, it presented nocorrelation with mortality through the survival curve analysis (p=0.25). Troponin I was associated not onlywith mortality showed by the chi-square test (p=0.006), but also with the survival curve analysis (p=0.021). There was an association with mortality when positive troponin I was present in myocardial dysfunction.