The relationship between troponin level and pneumonia severity index in pneumonia patients and oxidant-antioxidant balance

Pneumonias is a disease group that is frequently observed in pediatric and adult age groups worldwide with high mortality and morbidity rates and based upon high treatment costs, it is a matter of community health noteworthy. By favour of early and quick diagnosis, patient mortality and morbidity can be lessened, meanwhile unnecessary hospitalization in hospital wards and ICUs can be prevented. It is known that cardiac troponins (cTn) might be associated with some clinical pictures as well, excluding acute coronary syndrome. No comprehensive study has been recorded regarding the correlation between troponin level increase in pneumonia and severity of pneumonia in adults. Thiol is an organic compound containing sulfhydryl (-SH) group having a critical role in preventing any occurence of oxidative state of stress in cells. Ischemia-modified albumin, related to oxidant antioxidant mechanism, is a frequently used biomarker lately and it is detected that it increases in several inflammatory cases as well as increases in case of ischemia. In this study, we aspire to research the utility of troponin level in pneumonia to rate pneumonia biomarker and severity of pneumonia by evaluating the correlation of pneumonia severity index and oxidant antioxidant balance. In our study, 100 patients diagnosed with pneumonia and 100 healthy volunteers were compared based on the evaluation of troponin, native thiol, total thiol, disulfide, IMA, hemogram, biochemistry, postero-anterior chest radiography, ECG (electrocardiography), ECO (echocardiography), computed tomography of the thorax (CT) The histories, additional disease conditions and physical examination findings of the pneumonia patients were recorded. Pneumonia patients were categorised based upon outpatient treatment, inpatient treatment and ward/icu admission. Additionally, the patients were evaluated based upon pneumonia severity index. It was found out that the average age of the 100 patients diagnosed with pneumonia is 65.0 ± 15.1 and the average age of the control group is 59.0±16.0. %38 (v=38) of the pneumonia group is women while %62 (v=62) are men and %54 (v=54) of the control group is women while %46 (v=46) are men. (p values in order: p=0.071, p=0.102) In our study, troponin level in the pneumonia group is ranked higher than the control group. (p<0.05) Troponin level in the pneumonia group with pathological ECG and ECO was detected statistically higher than the group with no pathology. (p<0.05) The troponin level of pneumonia patients with normal ECG was detected within normal limits in the pneumonia group in comparison with the control group. Moderate significant positive correlation between pneumonia group troponin and CRP levels. (p<0.05) Strong significant positive correlation was detected between pneumonia group troponin and procalcitonin levels. (p<0.05) It was observed that there is a significant difference between stage 1 with 3,4,5 and stage 2 with 3,4,5 based upon the pneumonia group PSI stage troponin levels. In pneumonia, significant lowness was monitored in native thiol and total thiol levels in comparison with the control group. (p< 0.05) Statistically no difference was detected in disulfide levels between the pneumonia group and the control group (p>0.05) Statistically,the pneumonia group disulfide/native thiol ratio and disulfide/total thio ratio was detected higher than the control group. (p<0.05). Statistically, the pneumonia group native thiol/total thiol ratio was detected lower than the control group. IMA level in the pneumonia group was detected significantly higher than the control group. (p<0,05) In our study, we have come to the conclusion that in pneumonia cardiac troponin, serum IMA levels increased, native thiol, total thiol levels decreased. This is the first study that evaluated cardiac troponin level pneumonia in adults. It is expected that troponin shall be beneficial in the decision-making for hospitalization of the patient group with elevated troponin in pneumonia are accompanied by cardiac pathologies. It was also concluded that troponin was beneficial to take a decision on treating pneumonia patients as outpatient or inpatient and on hospitalization of patients in ward or ICU. More comprehensive new studies regarding this subject are warranted. Keywords: Pneumonia, cardiac troponin, thiol, disulfide, ischemia-modified albümin.