PURPOSE: Patients with septic shock often have elevated cardiac troponin levels. This study examines the relationship between elevated levels of cardiac troponin I in patients with septic shock and ventilator dependence with their selected outcomes.
METHODS: We performed a retrospective cohort study of patients admitted with septic shock to the medical intensive care unit (MICU) during five years. Elevated troponin I level was defined as > 0.5 mcg/l. The time to death was defined by the total number of days of MICU stay in septic patients who expired. Using two-tailed, unpaired Student's t-test, we examined the impact of elevated cardiac troponin levels on septic patients in terms of duration of mechanical ventilation among survivors and hospital stay among non-survivors.
RESULTS: A total of 54 patients were reviewed, among whom 24 (44.5%) patients had elevated troponin I (13 males, 11 females, mean age 69.8 yrs) and 30 (55.5%) patients had normal troponin I levels (16 males, 14 females, mean age 63.6 yrs). Patients with prior coronary artery disease were similar in both groups respectively n=14 (58.3%) vs. n=16 (53.3%). Mortality was similar in both groups respectively n=15 (62.5%) vs. n=18 (60%). Time to death among expired patients was significantly shorter among patients with elevated troponin levels (mean 4.33 Sd ± 0.29 vs. 5.72 Sd ± 0.37 days, 95% CI= 0.41 - 2.37, P=0.0071). Duration of mechanical ventilation was significantly longer in patients with elevated troponin levels (mean 9.89 Sd ± 1.54 vs. 7.00 Sd ± 0.44 days, 95% CI=: 1.47 –4.31, P=0.0004).
CONCLUSION: Our study was unable to detect an increase in mortality among septic patients with elevated cardiac troponin I but this marker was related to the severity of the illness and to complicated withdrawal from mechanical ventilation.
CLINICAL IMPLICATIONS: The addition of cardiac troponin I levels to the APACHE-II score may improve the prediction of severity and the mechanical ventilation course in patients with septic shock.
DISCLOSURE: Adel Blamoun, No Financial Disclosure Information; No Product/Research Disclosure Information