Relação entre injúria miocárdica e mediadores inflamatórios na sepse - Sepse: integrando a pesquisa básica e a investigação

• Autor(a) principal: Assunção, Murillo Santucci Cesar De [UNIFESP]
• Data de Publicação: 2018
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6628325; https://repositorio.unifesp.br/handle/11600/52421
• topic: Sepsis; Inflammatory mediators; High sensitivity cardiac troponin T; Hsctnt; Myocardial injury; N-terminal pro-brain natriuretic peptide; Critical care; Sepse; Mediadores inflamatórios; Injúria miocárdica; Terapia intensiva

Objective: The aim of this study was to evaluate the relationship between myocardial injury biomarkers (hs-cTnT and NT-ProBNP) with inflammatory mediators (IL-6, IL-1β, IL-8, IL-10, IL-12 / IL-23p40, IL17A, IL- 21 and TNF-a) and inflammatory biomarkers (CRP and PCT) in septic patients, and outcome by myocardial injury biomarkers measurements. Method: This was a prospective cohort study performed in three intensive care units, enrolling patients with sepsis (infection associated with organic dysfunction), and septic shock. (hypotension would refract the infusion of fluids requiring vasopressor). Blood samples were collected up to 48h after developed first organ dysfunction, D0, and the second blood sample was collected on the seventh day after inclusion in the study. D7. Results: From September 2007 to September 2010, 95 patients. In the septic group APACHE II was 19 (14; 22) and SOFA D0 was 8 (5; 10), diagnosis: sepsis 24.2% and septic shock 75.8%. Mortality on D7 was 14.8% and hospital mortality was 34.7%. In D0, NT-ProBNP correlated with IL-8 (r = 0.495, p <0.001) and IL-10 (r = 0.471, p <0.001). In Day7, both hs-cTnT and NT-ProBNP correlated with (r = 0.446, p < 0.001 and r = 0.495, p < 0.001; respectively). NT-ProBNP D0 was higher in non-survivors on mortality in seventh day (p = 0.029) and in-hospital mortality (p = 0.030). hs-cTnT D7 (p = 0.030) and NT-ProBNP D7 (p <0.001) were significantly higher in-hospital mortality. NT-ProBNP D7 (OR 9,28; IC95% 2,05-41.94, p=0,004) and hs-cTnT D7 (OR 10,93; IC95% 2.139 – 55.795, p=0,04) were independently associated with in-hospital mortality. Conclusion: In the present study, NT-ProBNP D0 correlated with IL-8 and IL-10. In addition, NT-ProBNP has been shown to be an important predictor of mortality, and hs-cTnT do not have performance as previous described in the literature, in this population of critically ill patients.