Elevated Cardiac Troponin T Levels in Critically Ill Patients with Sepsis

• Published in: The American journal of medicine Vol. 126; no. 12; pp. 1114 - 1121
• Main Authors: Vasile, Vlad C., MD, PhD, Chai, High-Seng, PhD, Abdeldayem, Doaa, MBBCh, Afessa, Bekele, MD, Jaffe, Allan S., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2013; Elsevier Sequoia S.A
• Subjects: Aged; Cardiac injury; Cardiovascular system; Critical care; Critical Illness - mortality; Female; Humans; Intensive care unit; Internal Medicine; Male; Middle Aged; Probability; Retrospective Studies; Sepsis; Sepsis - blood; Sepsis - mortality; Troponin; Troponin T - blood; Sepsis; Troponin; Cardiac injury; Intensive care unit
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2013.06.029

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.