Cord blood cardiac troponin I as an early predictor of short-term outcome in perinatal hypoxia


Turker G., Babaoglu K. , Gokalp A. S. , Sarper N. , Zengin E. , Arisoy A. E.

BIOLOGY OF THE NEONATE, vol.86, no.2, pp.131-137, 2004 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 86 Issue: 2
  • Publication Date: 2004
  • Doi Number: 10.1159/000079068
  • Title of Journal : BIOLOGY OF THE NEONATE
  • Page Numbers: pp.131-137
  • Keywords: hypoxic-ischemic encephalopathy, intrauterine hypoxia, mortality, cardiac troponin I, CEREBRAL ENERGY FAILURE, CEREBROSPINAL-FLUID, CREATINE-KINASE, PROGNOSTIC VALUE, GESTATIONAL-AGE, INFANTS, ISCHEMIA, PROTEIN, ENCEPHALOPATHY, MARKERS

Abstract

Background: In most perinatal-hypoxia survivors, myocardial dysfunction can be reversed with appropriate inotropic support and oxygenation. The main problem related to outcome is cerebral damage. Objective: We tested the hypothesis that cardiac troponin I (cTnI), a known marker of myocardial injury, is also an early predictor of severity of cerebral damage and mortality in intrauterine hypoxia. Methods: Venous and arterial cord blood samples were collected at delivery from 54 consecutive newborns with hypoxic-ischemic encephalopathy and from 50 consecutive healthy controls. Arterial blood gas analysis was performed and levels of cTnI, creatine kinase and creatine kinase-MB in venous cord blood were measured. The same serum parameters were also measured on the 3rd and 7th day of life. Results: Infants with hypoxia had a significantly higher cord blood cTnI levels than controls (p < 0.0001). Cord blood and 3rd and 7th day serum cTnI values showed a significant increase with severity of HIE (p < 0.0001). In non-survivors cord blood cTnI levels were significantly higher than the survivors (5.9 ng/ml, range 2.1-12.8, and 1.6 ng/ml, range 0.4 +/- 5.8, respectively; p < 0.0001). Receiver-operator curve analysis revealed cord cTnI as the most sensitive factor for predicting early death (area under curve = 0.956; SE: 0.028; 95% CI: 0.9-1.01). Cord blood cTnI of 4.6 ng/ml was identified as the optimal cut- off level for predicting serious risk of early mortality. Conclusion: The results suggest that significant elevation of cord cTnI is an excellent early predictor of severity of hypoxic-ischemic encephalopathy and mortality in term infants. Copyright (C) 2004 S. Karger AG, Basel.