Lactate and other clinicolaboratory predictors for subtle myocardial dysfunction in pediatric intensive care unit

IntroductionThis study aimed to determine the incidence of admission subtle myocardial dysfunction (SMD) in critically ill children by measuring cardiac troponin I (cTnI) and to identify clinicolaboratory risk factors.MethodsAdmission systolic blood pressure (SBP) registration. Categorizing patients into 2 groups: sepsis and nonsepsis. Laboratory investigations including: Hemoglobin, urea, creatinine, alanine aminotransferase (ALT); aspartate transaminase (AST) and serum troponin I (cTnI) and lactate.ResultsSixty-three patients were enrolled. Eleven (17.5%) patients had SMD. All SMD patients were in severe sepsis or septic shock having significant characteristics: (1) cTnI (median 0.7 ng/mL, P < 0.000), lactate (median 5.5 mmol/L. P < 0.000). (2) Age (median 6mo, P < 0.04) (3) SBP (median 73 mm Hg. P < 0.001) (4) ALT and AST (median 259 IU/dl and 586 IU/dl, P < 0.000 for each). (5) BUN and Creatinine (median 29 mg/dl, P < 0.002, median 1.4 mg/dl, P < 0.01, respectively). (6) Hemoglobin (median 7.2 g/dl, P < 0.003). Lactate Level > 3.3 mmol/L(95% CI −.9 to −.25, P < 0.001) and high ALT (95% CI −.002 to .000, P < 0.001) are predictors of SMD. High Lactate had a sensitivity of 90.9%, specificity of 89.9% with positive predictive value of 83.3%, negative predictive value of 94.1% and accuracy of 90%. for SMD. Patients with SMD had significant mortality.ConclusionSubtle myocardial dysfunction is detected in infants with severe sepsis and septic shock. SMD should be suspected in those patients showing high ALT and Lactate level > 3.3 mmol/L.