PURPOSE: To determine the prevalence of myocardial injury in patients with sepsis by measuring serum cardiac troponin-I (cTnI), to evaluate the relationship between elevated cTnI and presence of cardiac dysfunction and to determine if cTnI is a predictor of outcome.
METHODS: Retrospective analysis of 136 septic patients. ST-elevation MI were excluded. Demograhpics, echocardiographic findings, length of ICU & hospital stay, number of days on mechanical ventilation, APACHE-IIscore, and final outcome recorded. cTnI levels measured within 24–48 hours of admission and values considered positive if >0.60 ng/ml, gray zone if between 0.10–0.59 ng/ml, and negative if less than 0.1 ng/ml.
RESULTS: 136 sepsis patients, 49% male with mean age of 64 years. 25% had normal cardiac troponin, 55% had gray zone cTn-I and 21% patients had positive cTn-I. No statistically significant difference in APACHE-II scores among the 3 groups of patients. Patients with normal troponin had 41.1% hospital mortality compared to 31% in positive troponin group and 22.9% in the gray zone troponin group (p = 0.15). Patients with positive troponin have slightly longer length of stay in ICU & hospital 12.1 and 23.9 days compared to patients with normal troponin 9.3 and 18.5 days,and patients with gray zone troponin stayed 10.4 and 13.3 days (p=0.57 & 0.51 respectively). Number of days on mechanical ventilation were 15.1 days for the positive troponin, 8.9 ays for the gray zone troponin, and 7.8 days for the normal troponin (p=0.17). Abnormal ejection fraction (EF<50%) was seen in 37.9% of the positive troponin group, 18.6% of the gray zone troponin group, and 5.8% of the normal troponin group (p=0.005). However, there was no statistically significant mortality difference between patients with abnormal versus normal EF in each troponin group. Similarly number of ventilator days and length of ICU & hospital stay were not different between the abnormal and normal EF in each of the troponin groups.
CONCLUSION: Elevated cTnI is prevalent in ICU patients with sepsis and it predicts the presence of cardiac dysfunction in these patients. However in critically ill septic patients, elevated cTnI levels measured upon admission were not associated with increased morbidity or mortality rates.
CLINICAL IMPLICATIONS: Cardiac troponin predicts the presence of cardiac dysfunction in septic patients but it does not independently contribute to the prediction of mortality beyond that provided by APACHE II.
DISCLOSURE: Sepideh Moghadam, No Financial Disclosure Information; No Product/Research Disclosure Information