elevated cardiac troponin i in sepsis and septic shock no evidence for thrombus associated myocardial necrosis心肌肌钙蛋白升高我在脓毒症和脓毒性休克没有证据表明血栓相关的心肌坏死.pdfVIP

Elevated Cardiac Troponin I in Sepsis and Septic Shock: No Evidence for Thrombus Associated Myocardial Necrosis 1 2 3 4 1 1 David R. Altmann , Wolfgang Korte , Micha T. Maeder , Thomas Fehr , Philipp Haager , Hans Rickli , 5 6 1 Gian-Reto Kleger , Regulo Rodriguez , Peter Ammann * 1 Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland, 2 Institute for Clinical Chemistry and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland, ¨ ¨ 3 Baker IDI Heart and Diabetes Institute, Melbourne, Australia, 4 Division of Nephrology, University Hospital Zurich, Zurich, Switzerland, 5 Intensive Care Unit, Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland, 6 Institute of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland Abstract Background: Elevated cardiac troponin I (cTnI) is frequently observed in patients with severe sepsis and septic shock. However, the mechanisms underlying cTnI release in these patients are still unknown. To date no data regarding coagulation disturbances as a possible mechanism for cTnI release during sepsis are available. Methodology/Principal Findings: Consecutive patients with systemic inflammatory response syndrome (SIRS), sepsis or septic shock without evidence of an acute coronary syndrome were analyzed. Coagulation parameters (clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), a-angle) were assessed in native whole blood samples, and using specific activators to evaluate the ext