Serum troponin I level in children with diabetic ketoacidosis: a cross-sectional study
-
Nima Mehdizadegan
,
Homa Ilkanipoor
,
Pegah Rezaee
,
Negar Yazdani
,
Hamid Amoozgar
,
Fatemeh Sadat Mirrashidi
,
Hossein Moravej
Abstract
Background: Diabetic ketoacidosis (DKA) can cause several complications. The myocardial damage in children with DKA was not evaluated clearly. This study aimed to investigate the troponin level as a biochemical marker of myocardial damage in children with DKA during the disease and after recovery.
Methods: This cross-sectional study was conducted in the pediatric endocrinology department of Namazi Hospital, Shiraz, Iran, from May to December 2019. Fifty diabetic children aged 1 to 18 years old with DKA by census sampling method. All patients were examed, and electrocardiography (ECG) was carried out. Troponin level was measured at admission and 48 hours after recovery. Finally, data were analysed using SPSS software 20.
Results: At the time of admission, the mean troponin level was 11.56±5.35 ng/mL and it became 2.15±1.21 ng/mL after recovery. Although the initial troponin level during DKA in three patients was higher than the expected normal reference range, their echocardiography and ECG were normal. Moreover, there was no statistical relationship between troponin level with age, diabetes duration, and DKA severity.
Conclusion: The troponin level was remarkably different during DKA and after recovery. However, in merely 6% of DKA patients, the troponin level was higher than the expected value. We recommended that these patients be followed for future cardiovascular complications.
1. Abbas Q, Arbab S, Ul Haque A, Humayun KN. Spectrum of complications of severe DKA in children in pediatric Intensive Care Unit. Pak J Med Sci 2018;34(1):106. https://doi.org/10.12669/pjms.341.13875
2. Poovazhagi V. Risk factors for mortality in children with diabetic keto acidosis from developing countries. World J Diabetes 2014;5(6):932. https://dx.doi.org/10.4239%2Fwjd.v5.i6.932
3. Cashen K, Petersen T. Diabetic ketoacidosis. Pediatr Rev 2019;40(8):412-20.
4. Hoffman WH, Passmore GG, Hannon DW, Talor MV, Fox P, Brailer C, Haislip D, Keel C, Harris G, Rose NR, Fiordalisi I. Increased systemic Th17 cytokines are associated with diastolic dysfunction in children and adolescents with diabetic ketoacidosis. PLoS One 2013;8(8):e71905. https://doi.org/10.1371/journal.pone.0071905
5. Musher DM, Abers MS, Corrales-Medina VF. Acute infection and myocardial infarction. N Engl J Med 2019;380(2):171-6. https://doi.org/10.1371/journal.pone.0071905
6. Lindner G, Pfortmueller CA, Braun CT, Exadaktylos AK. Non-acute myocardial infarction-related causes of elevated high-sensitive troponin T in the emergency room: a cross-sectional analysis. Intern Emerg Med 2014;9(3):335-9. https://doi.org/10.1007/s11739-013-1030-y
7. Odubanjo AA, Kalisetti R, Adrah R, Ajenifuja A, Joseph B, Zaman M. Severe Myopericarditis in Diabetic Ketoacidosis—All Troponin are Not Myocardial Infarction. Clin Med Insights Case Rep 2018;11:1179547618763356. https://doi.org/10.1177/1179547618763356
8. Manikkan AT. Elevated troponin I levels in diabetic ketoacidosis without obstructive coronary artery disease. J Endocr Soc 2018;2(9):1020-3. https://doi.org/10.1210/js.2018-00152
9. Kaefer K, Botta I, Mugisha A, Berdaoui B, De Bels D, Attou R, Honoré PM, Redant S. Acute coronary syndrome and diabetic keto acidosis: the chicken or the egg?. Ann Transl Med 2019;7(16). https://dx.doi.org/10.21037%2Fatm.2019.07.38
10. Abdo AS, Geraci SA. Significance of elevated cardiac troponin I in patients with diabetic ketoacidosis. J Miss State Med Assoc 2013;54(5):127-30.
11. Sharma E, Dahal S, Sharma P, Ghimire DK, Dahal S. A case of pseudoinfarction pattern in diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Cardiol Res 2018;9(4):250. https://doi.org/10.14740/cr747w
12. Wray J, Yoo MJ, Bridwell RE, Tannenbaum L, Henderson J. ST-segment elevation in the setting of diabetic ketoacidosis: is it acute coronary syndrome?. Cureus 2020;12(3). https://dx.doi.org/10.7759%2Fcureus.7409
13. Shim HJ, Yoo BM, Jin SM, Kang MJ. Myocardial injury in a pediatric patient with diabetic ketoacidosis: A case report. Medicine 2021;100(17). https://dx.doi.org/10.1097%2FMD.0000000000025702
14. Aygün D, Aygün F, Nişli K, Baş F, Çıtak A. Electrocardiographic changes in children with diabetic ketoacidosis and ketosis. Turk Arch Pediatr 2017;52(4):194. https://dx.doi.org/10.5152%2FTurkPediatriArs.2017.4917
15. Strah D, Seckeler M, Mendelson J. Coronary artery spasm in a 15-year-old male in diabetic ketoacidosis. Cardiol Young 2021;31(9):1507-9. https://doi.org/10.1017/S1047951121000780
16. Halloum A, Al Neyadi S. Myocardial dysfunction associated with diabetic ketoacidosis in a 5-year-old girl. SAGE Open Med Case Rep 2019;7:2050313X19847797. https://doi.org/10.1177%2F2050313X19847797
17. Al‐Mallah M, Zuberi O, Arida M, Kim HE. Positive troponin in diabetic ketoacidosis without evident acute coronary syndrome predicts adverse cardiac events. Clin Cardiol 2008;31(2):67-71. https://doi.org/10.1002/clc.20167
18. Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19:155-77. https://doi.org/10.1111/pedi.12701
19. Peng W, Yuan J, Chiavaroli V, Dong G, Huang K, Wu W, Ullah R, Jin B, Lin H, Derraik JG, Fu J. 10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China). Front Endocrinol 2021;12:360. https://doi.org/10.3389/fendo.2021.653519
20. DePiero A, Kuppermann N, Brown KM, Schunk JE, McManemy JK, Rewers A, Stoner MJ, Tzimenatos L, Garro A, Myers SR, Quayle KS. Hypertension during diabetic ketoacidosis in children. J Pediatr 2020;223:156-63. https://doi.org/10.1016/j.jpeds.2020.04.066
21. Geddes J, Deans KA, Cormack A, Motherwell D, Paterson K, O'Reilly DS, Fisher BM. Cardiac troponin I concentrations in people presenting with diabetic ketoacidosis. Ann Clin Biochem 2007;44(4):391-3. https://doi.org/10.1258%2F000456307780945750
22. Eubanks A, Raza F, Alkhouli M, Glenn AN, Homko C, Kashem A, Bove A. Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome. Cardiovasc Diabetol 2012;11(1):1-8. https://doi.org/10.1186/1475-2840-11-154
2. Poovazhagi V. Risk factors for mortality in children with diabetic keto acidosis from developing countries. World J Diabetes 2014;5(6):932. https://dx.doi.org/10.4239%2Fwjd.v5.i6.932
3. Cashen K, Petersen T. Diabetic ketoacidosis. Pediatr Rev 2019;40(8):412-20.
4. Hoffman WH, Passmore GG, Hannon DW, Talor MV, Fox P, Brailer C, Haislip D, Keel C, Harris G, Rose NR, Fiordalisi I. Increased systemic Th17 cytokines are associated with diastolic dysfunction in children and adolescents with diabetic ketoacidosis. PLoS One 2013;8(8):e71905. https://doi.org/10.1371/journal.pone.0071905
5. Musher DM, Abers MS, Corrales-Medina VF. Acute infection and myocardial infarction. N Engl J Med 2019;380(2):171-6. https://doi.org/10.1371/journal.pone.0071905
6. Lindner G, Pfortmueller CA, Braun CT, Exadaktylos AK. Non-acute myocardial infarction-related causes of elevated high-sensitive troponin T in the emergency room: a cross-sectional analysis. Intern Emerg Med 2014;9(3):335-9. https://doi.org/10.1007/s11739-013-1030-y
7. Odubanjo AA, Kalisetti R, Adrah R, Ajenifuja A, Joseph B, Zaman M. Severe Myopericarditis in Diabetic Ketoacidosis—All Troponin are Not Myocardial Infarction. Clin Med Insights Case Rep 2018;11:1179547618763356. https://doi.org/10.1177/1179547618763356
8. Manikkan AT. Elevated troponin I levels in diabetic ketoacidosis without obstructive coronary artery disease. J Endocr Soc 2018;2(9):1020-3. https://doi.org/10.1210/js.2018-00152
9. Kaefer K, Botta I, Mugisha A, Berdaoui B, De Bels D, Attou R, Honoré PM, Redant S. Acute coronary syndrome and diabetic keto acidosis: the chicken or the egg?. Ann Transl Med 2019;7(16). https://dx.doi.org/10.21037%2Fatm.2019.07.38
10. Abdo AS, Geraci SA. Significance of elevated cardiac troponin I in patients with diabetic ketoacidosis. J Miss State Med Assoc 2013;54(5):127-30.
11. Sharma E, Dahal S, Sharma P, Ghimire DK, Dahal S. A case of pseudoinfarction pattern in diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Cardiol Res 2018;9(4):250. https://doi.org/10.14740/cr747w
12. Wray J, Yoo MJ, Bridwell RE, Tannenbaum L, Henderson J. ST-segment elevation in the setting of diabetic ketoacidosis: is it acute coronary syndrome?. Cureus 2020;12(3). https://dx.doi.org/10.7759%2Fcureus.7409
13. Shim HJ, Yoo BM, Jin SM, Kang MJ. Myocardial injury in a pediatric patient with diabetic ketoacidosis: A case report. Medicine 2021;100(17). https://dx.doi.org/10.1097%2FMD.0000000000025702
14. Aygün D, Aygün F, Nişli K, Baş F, Çıtak A. Electrocardiographic changes in children with diabetic ketoacidosis and ketosis. Turk Arch Pediatr 2017;52(4):194. https://dx.doi.org/10.5152%2FTurkPediatriArs.2017.4917
15. Strah D, Seckeler M, Mendelson J. Coronary artery spasm in a 15-year-old male in diabetic ketoacidosis. Cardiol Young 2021;31(9):1507-9. https://doi.org/10.1017/S1047951121000780
16. Halloum A, Al Neyadi S. Myocardial dysfunction associated with diabetic ketoacidosis in a 5-year-old girl. SAGE Open Med Case Rep 2019;7:2050313X19847797. https://doi.org/10.1177%2F2050313X19847797
17. Al‐Mallah M, Zuberi O, Arida M, Kim HE. Positive troponin in diabetic ketoacidosis without evident acute coronary syndrome predicts adverse cardiac events. Clin Cardiol 2008;31(2):67-71. https://doi.org/10.1002/clc.20167
18. Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19:155-77. https://doi.org/10.1111/pedi.12701
19. Peng W, Yuan J, Chiavaroli V, Dong G, Huang K, Wu W, Ullah R, Jin B, Lin H, Derraik JG, Fu J. 10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China). Front Endocrinol 2021;12:360. https://doi.org/10.3389/fendo.2021.653519
20. DePiero A, Kuppermann N, Brown KM, Schunk JE, McManemy JK, Rewers A, Stoner MJ, Tzimenatos L, Garro A, Myers SR, Quayle KS. Hypertension during diabetic ketoacidosis in children. J Pediatr 2020;223:156-63. https://doi.org/10.1016/j.jpeds.2020.04.066
21. Geddes J, Deans KA, Cormack A, Motherwell D, Paterson K, O'Reilly DS, Fisher BM. Cardiac troponin I concentrations in people presenting with diabetic ketoacidosis. Ann Clin Biochem 2007;44(4):391-3. https://doi.org/10.1258%2F000456307780945750
22. Eubanks A, Raza F, Alkhouli M, Glenn AN, Homko C, Kashem A, Bove A. Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome. Cardiovasc Diabetol 2012;11(1):1-8. https://doi.org/10.1186/1475-2840-11-154
| Files | ||
| Issue | Vol 17 No 4 (2022): J Teh Univ Heart Ctr | |
| Section | Letter to the Editor | |
| DOI | https://doi.org/10.18502/jthc.v17i4.11616 | |
| Keywords | ||
| Troponin Diabetic Ketoacidosis Pediatrics Cardiovascular Complications | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mehdizadegan N, Ilkanipoor H, Rezaee P, Yazdani N, Amoozgar H, Mirrashidi FS, Moravej H. Serum troponin I level in children with diabetic ketoacidosis: a cross-sectional study. J Tehran Heart Cent. 2022;17(4):252-254.
