Role of Admission Troponin-T and Serial Troponin-T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock.
J Am Heart Assoc. 2017 Sep 09;6(9):
Authors: Vallabhajosyula S, Sakhuja A, Geske JB, Kumar M, Poterucha JT, Kashyap R, Kashani K, Jaffe AS, Jentzer JC
Abstract
BACKGROUND: Troponin-T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin-T testing in the prognostication of these patients.
METHODS AND RESULTS: This was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin-T and significant delta troponin-T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in-hospital mortality. Secondary outcomes included 1-year mortality and lengths of stay. During this 8-year period, 944 patients met the inclusion criteria with 845 (90%) having an admission troponin-T ≥0.01 ng/mL. Serial troponin-T values were available in 732 (78%) patients. Elevated admission troponin-T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin-T was associated with higher severity of illness. Admission log10 troponin-T was associated with unadjusted in-hospital (odds ratio 1.6; P=0.003) and 1-year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin-T and log10 delta troponin-T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin-T remained an independent predictor of in-hospital mortality (odds ratio 1.4; P=0.04) and 1-year survival (hazard ratio 1.3; P=0.008).
CONCLUSIONS: In patients with sepsis and septic shock, elevated admission troponin-T was associated with higher short- and long-term mortality. Routine serial troponin-T testing did not add incremental prognostic value in these patients.
PMID: 28889100 [PubMed - in process]