Clinical research study
Elevated Cardiac Troponin T Levels in Critically Ill Patients with Sepsis

https://doi.org/10.1016/j.amjmed.2013.06.029Get rights and content

Abstract

Background

It is known that troponin elevations have prognostic importance in critically ill patients. We examined whether cardiac troponin T elevations are independently associated with in-hospital, short-term (30 days), and long-term (3 years) mortality in intensive care unit (ICU) patients admitted with sepsis, severe sepsis, and septic shock after adjusting for the severity of disease with the Acute Physiology, Age and Chronic Health Evaluation III system.

Methods

We studied the Mayo Clinic's Acute Physiology, Age and Chronic Health Evaluation III database and cardiac troponin T levels from patients admitted consecutively to the medical ICU. Between January 2001 and December 2006, 926 patients with sepsis had cardiac troponin T measured at ICU admission. In-hospital, short-term, and long-term all-cause mortality were determined.

Results

Among study patients, 645 (69.7%) had elevated cardiac troponin T levels and 281 (30.3%) had undetectable cardiac troponin T. During hospitalization, 15% of the patients with troponin T <0.01 ng/mL died compared with 31.9% of those with troponin T ≥0.01 ng/mL (P < .0001). At 30 days, mortality was 31% and 17% in patients with and without elevations, respectively (P < .0001). The Kaplan-Meier probability of survival at 1-, 2-, and 3-year follow-ups was 68.1%, 56.3%, and 46.8% with troponin T ≥0.01 ng/mL, respectively, and 76.4%, 69.1%, and 62.0% with troponin T <0.01 μg/L, respectively (P < .0001). After adjustment for severity of disease and baseline characteristics, cardiac troponin T levels remained associated with in-hospital and short-term mortality but not with long-term mortality.

Conclusions

In patients with sepsis who are admitted to an ICU, cardiac troponin T elevations are independently associated with in-hospital and short-term mortality but not long-term mortality.

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

References (45)

  • G. Rona

    Catecholamine cardiotoxicity

    J Mol Cell Cardiol

    (1985)
  • M. Maeder et al.

    Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides

    Chest

    (2006)
  • A. Prasad et al.

    Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction

    Am Heart J

    (2008)
  • V.Y. Dombrovskiy et al.

    Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003

    Crit Care Med

    (2007)
  • V.Y. Dombrovskiy et al.

    Occurrence and outcomes of sepsis: influence of race

    Crit Care Med

    (2007)
  • J.A. Russell

    Management of sepsis

    N Engl J Med

    (2006)
  • M.M. Parker et al.

    Profound but reversible myocardial depression in patients with septic shock

    Ann Intern Med

    (1984)
  • J.E. Parrillo

    Pathogenetic mechanisms of septic shock

    N Engl J Med

    (1993)
  • D.A. King et al.

    The role of cardiac troponin I as a prognosticator in critically ill medical patients: a prospective observational cohort study

    Crit Care

    (2005)
  • K. Thygesen et al.

    Universal definition of myocardial infarction

    Eur Heart J

    (2007)
  • J.E. Zimmerman et al.

    Evaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database

    Crit Care Med

    (1998)
  • K. Thygesen et al.

    Universal definition of myocardial infarction

    Circulation

    (2007)
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    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.

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