Prognostic Importance of Myocardial Injury in Critically Ill Dogs with Systemic Inflammation

• Published in: Journal of veterinary internal medicine Vol. 27; no. 4; pp. 895 - 903
• Main Authors: Langhorn, R., Oyama, M.A., King, L.G., Machen, M.C., Trafny, D.J., Thawley, V., Willesen, J.L., Tarnow, I., Kjelgaard-Hansen, M.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.07.2013; John Wiley & Sons, Inc
• Subjects: Animals; Biomarker; Biomarkers; Cardiac troponin; Cohort Studies; Companion animals; Critical Illness; Cytokines; Cytokines - blood; Cytokines - genetics; Cytokines - metabolism; Dog Diseases - etiology; Dog Diseases - pathology; Dogs; Emergency medical care; Female; Gene Expression Regulation; Heart attacks; Heart Diseases - etiology; Heart Diseases - pathology; Heart Diseases - veterinary; Inflammation - veterinary; Intensive care; Male; Medical prognosis; Mortality; Risk factors; Sepsis; Severity scores; Survival analysis; Troponin I - blood; Tumor necrosis factor-TNF; Veterinary medicine; Companion animals; Biomarker; Cardiac troponin; Severity scores
• DOI: 10.1111/jvim.12105
• ISSN: 0891-6640

Background In noncardiac critical disease in humans, myocardial injury as detected by cardiac troponin I and T (cTnI and cTnT) has been linked to high intensive care unit (ICU) death independent of prognostic composite scoring. Hypothesis Presence of myocardial injury predicts short‐term death in critically ill dogs with systemic inflammation and provides additional prognostic information when combined with established canine prognostic composite scores. Animals Forty‐two dogs admitted to the ICU with evidence of systemic inflammation and no primary cardiac disease. Methods Prospective cohort study. Blood samples were obtained at ICU admission for the measurement of cTnI and cTnT, C‐reactive protein, and several cytokines. The acute patient physiologic and laboratory evaluation (APPLE) score and the survival prediction index were calculated within the first 24 hours of admission. Receiver operating characteristic (ROC) curves were used to examine the prognostic capacity of each biomarker and severity score. Multiple logistic regression analysis was performed to evaluate whether cardiac markers significantly contributed to severity scores. Results Twenty‐eight day case fatality rate was 26% (11/42 dogs). cTnI concentrations were (median [range]) 0.416 [0.004–141.5] ng/mL and cTnT concentrations were 13.5 [<13–3,744] ng/L. cTnI, cTnT, and the APPLE score were all significant prognosticators with areas under the ROC curves [95% CI] of 0.801 [0.649; 0.907], 0.790 [0.637; 0.900], and 0.776 [0.621; 0.889], respectively. cTnI significantly contributed to the APPLE score in providing additional prognostic specificity (P = .025). Conclusions and Clinical Importance Markers of myocardial injury predict short‐term death in dogs with systemic inflammation and cTnI significantly contributes to the APPLE score.