Early myocardial dysfunction in pediatric sepsis: can biomarkers guide the first response?

Sep 29, 2026

Letter to the Editor examines early myocardial dysfunction (sepsis-induced myocardial dysfunction, SIMD) in children and the need for rapid, dependable biomarkers to support prompt monitoring and targeted vasoactive therapy before overt hemodynamic collapse. It reviews evidence for cardiac troponins (with age-adjusted 99th-percentile limits), NT-proBNP for ventricular stress and prognosis, and presepsin as an early innate-immune marker distinguishing bacterial from viral infection. The letter also highlights multimarker risk approaches such as PERSEVERE and discusses clinical integration with bedside echocardiography, while emphasizing current limitations and the need for larger multicenter validation.

LanguageEnglish

CategoryHealthcare

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Pages2

Reading Time5 min

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Letter to the Editor

Early myocardial dysfunction and the need for biomarkers

Cardiac troponins: diagnosis and age-adjusted limits

NT-proBNP and ventricular stress

Presepsin as an early innate-immune marker

Multimarker strategies and clinical pathways

Ethical approval and consent statements

Letter to the Editor Early myocardial dysfunction in pediatric sepsis: can biomarkers guide the first response? Mir Raza Ali, MBBSa , Abdul Khalique, MBBSa , Noor un nisa Irshad, MBBSb , Sakan Binte Imran, MBBSc ,* To the Editor, Sepsis remains a leading cause of critical illness in children, and early myocardial dysfunction (sepsis-induced myocardial dysfunction [SIMD]) significantly worsens outcomes. Rapid, dependable biomarkers that detect myocardial involvement before overt hemodynamic collapse could enable clinicians to commence prompt monitoring and targeted vasoactive therapy. Recent pediatric trials show potential for both cardiac-specific and sepsis-directed biomarkers when paired with bedside imaging, but current evidence remains largely exploratory, requiring larger, prospective multicenter validation before these biomarkers can be adopted as reliable tools[1–3]. Cardiac troponins, particularly high-sensitivity assays, detect myocardial damage and are increasingly being studied in pediatric populations. Age-adjusted reference limits are important because pediatric 99th-percentile thresholds differ from adult values; various studies have provided pediatric-specific limits and demonstrated that troponin increases correlate with decreased cardiac function on echocardiography[1–3]. High-sensitivity assays can identify minor injuries, but they must be interpreted carefully in an inflamed or septic youngster. Among current markers, cardiac troponins primarily serve a diagnostic role for myocardial injury, while NT-proBNP and presepsin provide complementary prognostic insights regarding disease severity and outcomes. The N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established indicator of ventricular stress. Elevated NT-proBNP levels in sepsis and septic shock are associated with disease severity and ventricular dysfunction on echocardiography. Recent research, particularly pediatric cohorts, has highlighted its prognostic usefulness while also emphasizing confounding factors such as age, renal function, and systemic inflammation[4,5] . Asa result, NT-proBNP is most effective when used in conjunction with other diagnostic tools rather than on its own. aDepartment of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, bDepartment of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan and cDepartment of Medicine, Sir Salimullah Medical College, Dhaka, Bangladesh Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Department of Medicine, Sir Salimullah Medical College, Dhaka 1100, [Bangladesh. E-mail: sakanbinteimran.ssmc@gmail.com](Bangladesh. E-mail: sakanbinteimran.ssmc@gmail.com) (S.B. Imran). Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons AttributionNoDerivatives License 4.0, which allows for redistribution, commercial and noncommercial, as longas it is passed along unchanged and in whole, with credit to the author. Annals of Medicine & Surgery (2026) 88:1082–1083 Received 18 October 2025; Accepted 16 November 2025 Published online 25 November 2025 [http://dx.doi.org/10.1097/MS9.0000000000004442](http://dx.doi.org/10.1097/MS9.0000000000004442) Presepsin (sCD14-ST), an early innate-immune marker generated after bacterial activity, has received interest in pediatric sepsis due to its rapid rise and ability to distinguish bacterial from viral infections. Pediatric studies demonstrate that presepsin has better early diagnostic performance than CRP or procalcitonin, and its kinetics may assist in identifying children at risk of early organ dysfunction, such as cardiac involvement[6,7] . Recent pediatric research has progressed beyond single biomarkers. Multimarker risk approaches, such as the Pediatric Sepsis Biomarker Risk Model (PERSEVERE), use inflammatory, endothel

FAQs

What is the proposed approach for clinical use of biomarkers?

Biomarkers should be incorporated into sepsis care pathways and used alongside bedside echocardiography and clinical assessment rather than replacing them, with multimarker strategies considered emerging pending wider validation.

Sep 29, 2026

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