Prognostic value of troponins in sepsis: a meta-analysis

Bessière, Francis; Khenifer, S.; Dubourg, Julie; Durieu, I.; Lega, Jean‐Christophe

doi:10.1007/s00134-013-2902-3

Cited by 151 publications

(119 citation statements)

References 35 publications

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“…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%

“…A prior meta‐analysis of observational studies demonstrated increased all‐cause mortality in patients with elevated troponin (relative risk 1.9, 95% CI, 1.6–2.2). However, only 3 studies used TnT values 2. By contrast, other investigators have failed to validate troponin as an independent predictor of mortality in addition to severity of illness scores 9, 27, 28, 29…”

Section: Discussionmentioning

confidence: 99%

“…Sepsis is a leading cause of death and disability in the United States, resulting in a similar number of fatalities as acute myocardial infarction (AMI) each year 1, 2. Cardiovascular dysfunction occurs in nearly 70% of septic patients and can manifest as hemodynamic instability, cardiac biomarker elevation, myocardial dysfunction on echocardiography, and end‐organ hypoperfusion 3.…”

Section: Introductionmentioning

confidence: 99%

“…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%

“…TnT levels in patients with sepsis correlate with duration of hypotension and extent of vasopressor support 11, 12, 13. Prior studies evaluating the role of troponins in sepsis and septic shock were limited by the use of different troponin assays, small sample sizes, variations in definitions of elevated troponin levels, and loss of patients to follow‐up 2. These studies display marked heterogeneity because of lack of uniform adaptation of the 99th percentile of the upper reference limit as the standardized cutoffs 14.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

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Cardiac troponin as a prognosticator of mortality in patients with sepsis: A systematic review and meta‐analysis

Zheng,

Wang,

Guo

et al. 2023

Immunity Inflam & Disease

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BackgroundThe impact of cardiac troponin on the short‐term and long‐term prognosis of patients with sepsis remains uncertain. Therefore, we conducted a meta‐analysis to investigate the role of cardiac troponin as a potential indicator for sepsis mortality.MethodsWe performed a comprehensive search for articles published before November 2022 using Google Scholar, PubMed, and Web of Science. Inclusion criteria for the studies were: (1) investigation of cardiac troponin, and (2) investigation of sepsis. Exclusion criteria included: (1) inability to obtain or calculate hazard ratio (HR) and 95% confidence interval (CI) for the relationship between cardiac troponin level and sepsis mortality, and (2) reviews, meta‐analyses, and case reports. Analysis of HRs and 95% CIs for the association between cardiac troponin level and sepsis mortality was conducted using STATA 12.0 software.ResultsOur study included 24 prospective studies (comprising 20,457 sepsis patients) and 4 retrospective studies (comprising 1416 sepsis patients). Meta‐analysis demonstrated that elevated cardiac troponin levels were significantly associated with increased sepsis mortality using a random effects model (HR = 1.57, 95% CI 1.41−1.75). Moreover, elevated cardiac troponin levels were also significantly associated with increased hospital mortality of sepsis (HR = 1.35, 95% CI 1.19−1.53) and long‐term mortality of sepsis (HR = 1.96, 95% CI 1.51−2.55) using the random effects model.ConclusionsOverall, our finding revealed that elevated cardiac troponin for sepsis patients was a predictor of hospital and long‐term mortality. Clinicians may treat septic patients with elevated cardiac troponin more cautious to avoid extra death. Moreover, large clinical studies are warranted to validate this association.

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Predictors of short‐ and long‐term mortality in hospitalized veterans with elevated troponin

Winchester

Burke

Agarwal

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Cardiac troponin elevation is associated with mortality. We compared the mortality risk related to elevated troponin from acute coronary syndrome (ACS) and non‐ACS causes in a hospitalized elderly veteran population. METHODS AND RESULTS As part of a quality initiative at our Veterans Affairs hospital, all patients with elevated troponin were evaluated by a cardiologist to determine if ACS was present and to recommend management. We selected a sample (n = 761) of consecutive patients studied between February 2006 and February 2007 and examined all‐cause mortality over extended follow‐up. Nearly all were men (99.1%), and about half had coronary disease (n = 385, 50.5%) and diabetes (n = 339, 44.4%). ACS patients had lower mortality that non‐ACS patients. Mortality began to diverge at 30 days; at 1 year it was 42.0% versus 29.0% (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.41‐0.78) and at 6 years 77.7% versus 58.7% (OR: 0.41, 95% CI: 0.30‐0.56). Cox regression models for mortality at multiple time points yielded several independent factors associated with mortality; however, the distribution of the factors was not sufficient to explain the observed difference in mortality. CONCLUSIONS In this elderly, male veteran population, mortality related to an elevated troponin was higher at 1 and 6 years for non‐ACS patients compared with ACS patients. Factors independently associated with a higher mortality risk were predominantly markers of general systemic illness, but did not elucidate the reasons why troponin elevation secondary to non‐ACS causes carries this higher risk. A better understanding of these cardiac troponin elevations and implications for future mortality requires additional investigation. Journal of Hospital Medicine 2016;11:773–777. © 2016 Society of Hospital Medicine

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Prognostic value of troponins in sepsis: a meta-analysis

Abstract: Elevated troponin identifies a subset of patients with sepsis at higher risk of death. Further studies are needed to define the precise role of troponins and their optimal cut-offs.

Cited by 151 publications

References 35 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

Cardiac troponin as a prognosticator of mortality in patients with sepsis: A systematic review and meta‐analysis

Predictors of short‐ and long‐term mortality in hospitalized veterans with elevated troponin

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