Elevated Cardiac Troponin T Levels in Critically Ill Patients with Sepsis

Vasile, Vlad C.; Chai, High Seng; Abdeldayem, Doaa; Afessa, Bekele; Jaffe, Allan S.

doi:10.1016/j.amjmed.2013.06.029

Cited by 71 publications

(52 citation statements)

References 47 publications

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“…We have previously demonstrated TnT to be a marker of short‐term mortality using a similar cutoff of 0.01 ng/mL on septic patients admitted from 2001 through 2006 16. In contrast to the current findings, other authors have associated elevated troponins with longer lengths of ICU and hospital stays in septic patients 23, 24.…”

Section: Discussioncontrasting

confidence: 89%

“…Admission TnT values were defined as the first measured TnT level within 6 hours of ICU admission. An elevated admission TnT level was defined as TnT ≥0.01 ng/mL consistent with the assay used and prior data from our center 6, 16. A significant delta TnT level was defined as a rise in 3‐ and 6‐hour TnT ≥0.03 ng/mL compared with the admission TnT value.…”

Section: Methodsmentioning

confidence: 96%

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Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Vallabhajosyula

Sakhuja

Geske

et al. 2017

JAHA

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BackgroundTroponin‐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 ResultsThis 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).ConclusionsIn 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.

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Section: Discussioncontrasting

confidence: 89%

Section: Methodsmentioning

confidence: 96%

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Vallabhajosyula

Sakhuja

Geske

et al. 2017

JAHA

Self Cite

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“…Of the 926 patients studied, 645 (69.7%) patients had detectable cTnT levels. After adjustment for severity of disease and baseline characteristics, cTnT levels remained associated with in-hospital and short-term mortality [87]. There was no statistically significant association with long-term mortality.…”

Section: Prognostic Applications Of Medium Sensitivity Ctn Assaysmentioning

confidence: 78%

High sensitivity cardiac troponin assays in the clinical laboratories

Jarolím

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

117

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Abstract:Immunoassays measuring cardiac troponins I or T have become firmly established as critical tools for diagnosing acute myocardial infarction. While most contemporary assays provide adequate diagnostic performance, the increased sensitivity and precision of the new, high sensitivity assays that have already been introduced into clinical practice, provide the potential to further shorten intervals between blood draws or the time needed to detect the first significant troponin elevation. In addition to the relatively modest benefits at the diagnostic end, the high sensitivity assays and the investigational ultrasensitive cardiac troponin assays offer improvements for predicting major adverse cardiovascular events, development of heart failure or transition to end-stage kidney disease. These novel high sensitivity assays can measure troponin concentrations in 50%-100% of healthy individuals and therefore allow for the distribution of troponin values within a healthy cohort to be measured, patient's baseline troponin levels to be monitored, and clinicians to be alerted of deteriorating cardiorenal conditions. We envisage that the high sensitivity assays will become important tools for predicting each patient's risk of future adverse events and for guiding and monitoring corresponding adjustments of preventative therapeutic interventions.

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“…6,15,[19][20][21][22][23][24][25] A meta-analysis covering observational studies until September 2010, showed that raised troponin, in the context of sepsis, is significantly associated with all-cause mortality (RR 1.91; 95% CI 1.63-2.24), in univariate analysis. 10 This meta-analysis included low quality studies (great number of retrospective studies and non-consecutive series and absence of blinding of physicians involved) and the results of meta-regression lacked power and therefore the potential for robust conclusion was limited.…”

mentioning

confidence: 99%

Raised cardiac troponin in intensive care patients with sepsis, in the absence of angiographically documented coronary artery disease: A systematic review

Zochios

Valchanov

2014

Journal of the Intensive Care Society

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Elevated cardiac troponin in the critically ill has been associated with increased hospital mortality. However, in critically ill patients with sepsis the results are heterogeneous and less easy to interpret. The objectives of this systematic review were to describe the pathophysiology, clinical relevance and prognostic significance of raised troponin in intensive care patients with sepsis. Articles were identified through a detailed MEDLINE search and additional references were retrieved from the selected studies. A growing body of clinical evidence suggests that although troponins are sensitive biomarkers with prognostic value, they are not independent predictors of mortality. However, vigilance for objective evidence of coronary artery disease is required and patients with atherosclerotic risk factors and elevated troponins may benefit from cardiac imaging. In patients with low pre-test probability for coronary artery disease and elevated troponins, therapy should target management of sepsis and optimisation of myocardial oxygen demand/supply balance.

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Elevated Cardiac Troponin T Levels in Critically Ill Patients with Sepsis

Cited by 71 publications

References 47 publications

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

High sensitivity cardiac troponin assays in the clinical laboratories

Raised cardiac troponin in intensive care patients with sepsis, in the absence of angiographically documented coronary artery disease: A systematic review

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