Skeletal troponin I in serum and diaphragmatic ultrasound in mechanically ventilated intensive care unit patients: a prospective observational study
CCCF ePoster library. Spadaro S. 11/12/19; 283439; EP89
Prof. Dr. Savino Spadaro
Prof. Dr. Savino Spadaro
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Topic: Retrospective or Prospective Cohort Study or Case Series

Spadaro, Savino1; Dalla Corte, Francesca1; Chiaveri, Valentina1; Cricca, Valentina1; Alvisi, Valentina1; Trentini, Alessandro2; Marangoni, Elisabetta1; Volta, Carlo Alberto1
1Section of Anesthesia and Intensive Care, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
2Section of Medical Biochemistry, Molecular Biology and Genetics, Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy

Introduction: Prolonged mechanical ventilation can cause muscle atrophy and adversely affect diaphragmatic force-generating function [1]. Diaphragmatic ultrasound has been proposed as a bedside daily monitoring of diaphragm function [2]; however, to date there are no specific serum biomarkers for muscular damage and dysfunction. Foster et al. [3] suggested that skeletal troponin I (sTnI) could be a sensitive marker to detect early signs of muscle injury.
Objectives: Firstly, to evaluate the trend of traditional and novel biomarkers of muscular damage in mechanically ventilated intensive care unit (ICU) patients; secondly, to determine whether this trend was associated with a consistent change in diaphragmatic function indices assessed by ultrasound. 
Methods: In this prospective, single centre, observational study serum samples were obtained from 102 mechanically ventilated ICU patients at 24 (T0), 48 (T1) and 72 (T3) hours after admission. Patients were not considered for inclusion if they had a history of neuromuscular disease or a previously documented diaphragm paralysis. Specimens were analysed and traditional muscular damage markers (CPK, aldolase and myoglobin) and specific isoforms for sTnI (slow (ssTnI) and fast (fsTnI)) were assayed. Simultaneously, in a subset of 69 patients diaphragmatic displacement (DD) and thickening fraction (TF) were measured with ultrasound. Values were compared using Friedman ́s analysis for repeated measures; Spearman test was used to test for bivariate correlations; p < 0.05 was considered statistically significant.
Results: Among the serum markers analyzed, CPK and myoglobin decreased significantly between T0 and T2 (p < 0.0001). fsTnI showed a decreasing trend (p = 0.112), while there was no change in ssTnI values during the first 72 hours of ICU stay. Both DD and TF decreased significantly over time (p < 0.0001). fsTnI levels at the baseline was correlated both with TF (r = 0.339, p = 0.005) and DD (r = 0.427, p < 0.001). 
Conclusion: Our results showed that both traditional muscular damage markers and sfTnI decreased over time in mechanically ventilated ICU patients possibly indicating muscle atrophy. Diaphragamtic ultrasound showed a decrease in diaphragmatic function over time. The correlation between ultrasound indices and sfTnI at the baseline might indicate the use of this novel biomarker to detect early signs of muscle injury.

[1] Vassilakopoulos T et al. Am J Respir Crit Care Med 2004;169:336–341; [2] Goligher EC et al. Am J Respir Crit Care Med 2015;192:1080–1088; [3] Foster G et al. Eur J Appl Physiolg 2012;112:3547–3558.

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