Biochemical Markers of Cardiac Injury in Normal, Surviving Septic, or Nonsurviving Septic Neonatal Foals

Abstract

The cardiac biomarkers cardiac troponin T (cTnT) and I (cTnI) and the cardiac isoenzyme of creatine kinase (CKMB) are used extensively in human medicine to diagnose and provide valuable prognostic information in patients with ischemic, traumatic, and septic myocardial injury. We designed a study to establish normal values for these markers in healthy, neonatal foals and to compare them with values obtained from septic neonates in a referral hospital population. The 25th, 50th, 75th, and 95th percentiles for cTnI and CKMB in the healthy-foal population were 0.08, 0.14, 0.25, 0.49 ng/mL and 1.4, 2.3, 4.0, 7.4 ng/mL, respectively. The values obtained for cTnT were frequently (43/52 foals; 83%) below the lower limit of detection of the assay (0.009 ng/mL), but the median and range were 0.009 and 0.009-0.041 ng/mL, respectively. In the septic foal population, the 25th, 50th, 75th, and 95th percentile values for cTnI and CKMB were 0.05, 0.12, 0.22, and 1.10 ng/mL and 2.0, 4.4, 7.8, and 24 ng/mL, respectively. The values obtained for cTnT were less frequently below the lower limit of detection (23/38 foals; 60%) compared with the healthy foal population, and the median and range were 0.009 and 0.009-0.20 ng/mL, respectively. Significantly higher values were observed for cTnT and CKMB in septic foals compared with the healthy neonatal foal population, but there were no differences among septic foals in survivors compared with nonsurvivors. These findings suggest that myocardial injury occurs during septicemia in neonatal foals but that the injury is not associated with survival among septic foals.

Comparison of viscoelastic coagulation analysis and standard coagulation profiles in critically ill neonatal foals to outcome

“…Foal survival in this study was approximately 67%, slightly higher than previously reported survival rates of 44.6% 32 and 61% 33 in similarly described septic foal groups treated at referral veterinary institutes. This survival rate is close to that of patients identified as having septic shock in human critical care 28 .…”

Preliminary Investigation of Cardiac Troponin I Concentration in Cows with Common Production Diseases

“…Increased cTnI concentrations have been identified in people with noncardiac diseases such as sepsis or septic shock, pulmonary embolism and chronic obstructive pulmonary disease . Similar findings have been reported in septic foals, calves with experimentally induced endotoxemia, laboratory animals after chemotherapy, dogs with renal failure and noncardiac systemic disease, gastric dilatation‐volvulus and in horses with surgical colic …”

“…Cardiac TnI concentration also correlated well with severity of disease and was associated with an adverse outcome in dogs with babesiosis . Increased cTnI and T concentrations also were observed in septic neonatal foals, but no significant difference was found between surviving and nonsurviving foals in that study …”

Cardiac troponins

“…Little work has been done to evaluate cTn levels during sepsis in veterinary medicine. A study involving septic foals showed that cTnT values were significantly elevated compared with healthy foals but there was no difference in levels among survivors compared with nonsurvivors 81 …”