Clinical research studyElevated Cardiac Troponin T Levels in Critically Ill Patients with Sepsis
Section snippets
Study Patients
We examined the APACHE III database and cardiac troponin T levels of consecutive patients with sepsis who were admitted to the ICU at Mayo Clinic, Rochester, Minnesota, between January 2001 and December 2006. The investigation was approved by the institutional review board. Patients were categorized according to the APACHE III body system, admission diagnosis, and description of disease.14 An admission diagnosis of “sepsis” was established if patients met the criteria of systemic inflammatory
Study Population
During the study period, 1105 consecutive patients with sepsis were admitted to the ICU. Of these patients, 926 (83.8%) had a cardiac troponin T value on admission and constitute our study population. Patients who were tested for cardiac troponin T were older, had a higher predicted in-hospital mortality rate and APACHE III score, and were more likely to have diabetes, hypertension, acute myocardial infarction, prior myocardial infarction, coronary artery bypass graft, and heart failure (Table 1
Discussion
Our results demonstrate higher risk ratios for in-hospital and short-term mortality in patients with cardiac troponin T elevations in a large unselected cohort of patients with sepsis who were admitted to the ICU. Detectable cardiac troponin T levels were independently associated with in-hospital and short-term (30 days) mortality, but not with long-term mortality, after adjustment for the severity of the disease as assessed by the APACHE III prognostic system, cardiovascular comorbidities, and
Conclusions
Our data support the utility of cardiac troponin T measurements in critically ill patients who were admitted to the ICU with a diagnosis of sepsis. Our study emphasizes the immediate prognostic information provided by cardiac troponin T independently of disease severity. Patients with a lower severity of presenting illness and without known cardiovascular disease have a marked increase in risk if they have an elevated cardiac troponin T. Our results suggest that specifically patients with lower
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Cited by (68)
Use and Prognostic Implications of Cardiac Troponin in COVID-19
2023, Heart Failure ClinicsUse and Prognostic Implications of Cardiac Troponin in COVID-19
2022, Cardiology ClinicsCitation Excerpt :A recent study28 comparing COVID-19 with influenza patients showed that, despite a higher absolute risk of death in patients with COVID-19, myocardial injury was frequent and increased the risk of death in both diseases. Moreover, acute myocardial injury is common in critically ill patients,29 in those with acute respiratory distress,30 and sepsis.31 In our COVID-19 study,27 we found that critical illness and sepsis could be identified as drivers of cTn increases in about 40% of patients.
High-sensitivity troponin T is an important independent predictor in addition to the Simplified Acute Physiology Score for short-term ICU mortality, particularly in patients with sepsis
2019, Journal of Critical CareCitation Excerpt :Using hsTnT alone as a predictor resulted in a better AUC than SAPS 3 for the ‘sepsis’ group (AUC 79.3% vs 71.2%); furthermore, combining hsTnT and SAPS 3 resulted in an AUC of 83.1%. These diagnosis-specific findings correspond well with previous findings; previous studies suggest that troponin-T is associated with increased short- and long-term mortality [17,19,24]. However, the positive effect on prognostic predictive ability we identified after addition of hsTnT to SAPS 3, for septic patients, was greater than anticipated.
Acute Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin I Levels in Adult Patients with Early Sepsis at a Tertiary Referral Center in Mexico: An Exploratory Study
2024, Journal of Cardiovascular Development and Disease
Funding: None.
Conflict of Interest: ASJ has consulted or presently consults for most of the major diagnostic companies, including Beckman-Coulter, Alere, Critical Diagnostics, Radiometer, Amgen, Ortho Diagnostics, Abbott Diagnostics, and Roche, which manufactured the assay used in this study. The other authors have no conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.