Elevation of troponin I in sepsis and septic shock

Ammann, Peter; Fehr, Thomas; Minder, Elisabeth I.; Günter, Christina Irene; Bertel, Osmund

doi:10.1007/s001340100920

Cited by 328 publications

(274 citation statements)

References 0 publications

Supporting

Mentioning

236

Contrasting

Unclassified

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…The timing of troponin measurement, troponin assay used (ie, TnT versus TnI), and hemodynamic stability at the time of troponin measurement differ substantially in prior studies 2, 7, 8. The majority of prior studies have examined short‐term mortality, while this study included assessment of 1‐year death rate.…”

Section: Discussionmentioning

confidence: 99%

“…Flow‐limiting coronary artery disease is infrequently documented in these patients, alluding to alternate mechanisms of TnT elevation other than AMI 8. Electrocardiography and echocardiography in these patients rarely demonstrate ischemic changes, and few patients have inducible ischemia on stress testing or occlusive coronary thrombus on autopsy 8, 26, 30. Postulated causes for troponin elevations in septic patients include ischemic mechanisms (eg, supply–demand imbalance or microvascular spasm or thrombosis) and nonischemic mechanisms (eg, reversible myocardial membrane leakage of cytosolic TnT pool or direct cellular toxicity from inflammatory mediators, microbial toxins, or excessive catecholamine levels) 7, 31, 32.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac TnT levels correlate with the presence of left ventricular systolic and diastolic dysfunction and right ventricular dysfunction on echocardiography 8, 9, 10. TnT levels in patients with sepsis correlate with duration of hypotension and extent of vasopressor support 11, 12, 13.…”

Section: Introductionmentioning

confidence: 97%

“…Up to 85% of patients with sepsis and septic shock have detectable cardiac TnT levels using standard troponin assays, and troponin levels have demonstrated a variable association with mortality 2, 8. Cardiac TnT levels correlate with the presence of left ventricular systolic and diastolic dysfunction and right ventricular dysfunction on echocardiography 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

Elevated Cardiac Troponin Measurements in Critically Ill Patients

Lim

Qushmaq²,

Devereaux³

et al. 2006

Arch Intern Med

169

143

View full text Add to dashboard Cite

Background:The clinical significance of elevated cardiac troponin (cTn) level in patients in the intensive care unit (ICU) is uncertain. We reviewed the frequency of cTn elevation and its association with mortality and length of ICU stay in these patients.Methods: Studies were identified using MEDLINE, EMBASE, and reference list review. We included observational studies of critically ill patients that measured cTn at least once and reported the frequency of elevated cTn or outcome (mortality and length of ICU or hospital stay). We pooled the odds ratios (ORs) using the inverse variance method in studies that conducted multivariable analysis to examine the relationship between elevated cTn and mortality (adjusted analysis). We calculated the weighted mean difference in length of stay between patients with and without elevated cTn and pooled the results using the inverse variance method (unadjusted analysis).Results: A total of 23 studies involving 4492 critically ill patients were included. In 20 studies, elevated cTn was found in a median of 43% (interquartile range, 21% to 59%) of 3278 patients. In adjusted analysis (6 studies comprising 1706 patients), elevated cTn was associated with an increased risk of death (OR, 2.5; 95% confidence interval [CI], 1.9 to 3.4; PϽ.001). In the unadjusted analysis (8 studies comprising 1019 patients), elevated cTn was associated with an increased length of ICU stay of 3.0 days (95% CI, 1.0 to 5.1 days; P=.004) and an increased length of hospital stay of 2.2 days (95% CI, −0.6 to 4.9; P=.12).Conclusions: Elevated cTn measurements among critically ill patients are associated with increased mortality and ICU length of stay. Research is needed to clarify the underlying causes of elevated cTn in this population and to examine their clinical significance.

show abstract