비 순환기계 중환자의 예후 인자로서의 Troponin-I, Lactate, C-reactive protein의 유용성

Abstract

Background: The severity scoring system is useful for predicting the outcome of critically ill patients. However, the system is quite complicated and cost-ineffective. Simple serologic markers have been proposed to predict the outcome, which include troponin-I, lactate and C-reactive protein(CRP). The aim of this study was to evaluate the prognostic values of troponin-I, lactate and CRP in critically ill non-cardiac patients. Methods: From September 2003 to June 2004, 139 patients(Age: 63.3±14.7, MF = 88:51), who were admitted to the MICU with non-cardiac critical illness at Gyeongsang National University Hospital, were enrolled in this study. This study evaluated the severity of the illness and the multi-organ failure score (Acute Physiologic and Chronic Health Evaluation II, Simplified Acute Physiologic Score II and Sequential Organ Failure Assessment) and measured the troponin-I, lactate and CRP within 24 hours after admission in the MICU. Each value in the survivors and non-survivors was compared at the 10th and 30th day after ICU admission. The mortality rate was compared at 10th and 30th day in normal and abnormal group. In addition, the correlations between each value and the severity score were assessed. Results: There were significantly higher troponin-I and CRP levels, not lactate, in the non-survivors than in the survivors at 10th day(1.018±2.58ng/ml, 98.48±69.24mg/L vs. 4.208±10.23ng/ml, 137.69±70.18 mg/L) (p<0.05). There were significantly higher troponin-I, lactate and CRP levels in the non-survivors than in the survivors on the 30th day (0.99±2.66ng/ ml, 8.02±9.54ng/dl, 96.87±68.83mg/L vs. 3.36±8.74ng/ml, 15.42±20.57ng/dl, 131.28±71.23mg/L) (p<0.05). The mortality rate was significantly higher in the abnormal group of troponin-I, lactate and CRP than in the normal group of troponin-I, lactate and CRP at 10th day(28.1%, 31.6%, 18.9% vs. 11.0%, 15.8%, 0%) and 30th day(38.6%, 47.4%, 25.8% vs. 15.9%, 21.7%, 14.3%) (p<0.05). Troponin-I and lactate were significantly correlated with the SAPS II score(r2 = 0.254, 0.365, p<0.05). Conclusion: Measuring the troponin-I, lactate and CRP levels upon admission may be useful for predicting the outcome of critically ill non-cardiac patients.