Critical care : the official journal of the Critical Care Forum
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Editorial Comment
Acute liver failure and elevated troponin-I: controversial results and significance?
Acute liver failure in ICU patients is an often fatal condition in which many patients may die of multiple organ failure in the absence of liver transplantation. In this setting, cardiac injury may be associated with or precipitate a fatal outcome. Troponin-I is a well-established, specific, and sensitive surrogate of acute coronaropathy, with both diagnostic and prognostic value. ⋯ Despite a previous well-conducted US study showing that elevated troponin-I is associated with an independent risk of poor outcome and mortality, a recent UK study did not confirm these data and reported contradictory results. Troponin-I elevation observed in acute liver failure may therefore not represent true myocardial injury and may be better viewed as a marker of metabolic stress. The debate on the significance of elevated troponin-I in acute liver failure patients is revived.
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Editorial Comment
BTLA as a biomarker and mediator of sepsis-induced immunosuppression.
Recent research indicates that T-lymphocyte dysfunction may contribute to sepsis-associated morbidity and mortality. B and T lymphocyte attenuator (BTLA) is a co-inhibitory receptor expressed by T lymphocytes and B lymphocytes that is important in regulating lymphocyte activation during inflammation and infection. ⋯ Further studies provide evidence that BTLA activation contributes to T-lymphocyte apoptosis during sepsis. Although this study will require follow-up and further investigation, the results advance current knowledge regarding potential mechanisms underlying sepsis-induced immunosuppression and identify BTLA as a candidate biomarker and mediator of T-cell dysfunction during sepsis.