Use of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 as prognostic indicators in patients with sepsis

Abstract

Sepsis is a heterogeneous syndrome caused by the immune response to severe infection. This study aimed to investigate the value of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels for predicting death in patients with sepsis. Patients with sepsis who were hospitalized in the Department of Critical Care Medicine at our hospital between June 2017 and October 2022 were included in this retrospective study and divided into a survival group and a death group according to their survival status after 28 days. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, and levels of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 were measured. A total of 516 patients were included in the analysis. Multivariable analysis showed that the APACHE II score (P < .001), SOFA score (P < .001), and cardiac troponin I (P < .001), lactic acid (P = .002), procalcitonin (P < .001), and serum complement C3 (P = .01) levels were independent predictors of sepsis death. The area under the receiver operating characteristic curve (AUC) was 0.882 (95% CI: 0.794–0.941) in patients with sepsis predicted using a combination of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels, which was better than the predictive value of cardiac troponin I (AUC: 0.734, 95% CI: 0.628–0.824), lactic acid (AUC: 0.686, 95% CI: 0.576–0.781), procalcitonin (AUC: 0.727, 95% CI: 0.620–0.817), or serum complement C3 (AUC: 0.684, 95% CI: 0.575–0.780) alone. Cardiac troponin I, lactic acid, and procalcitonin levels are independent predictors of death, whereas serum complement C3 protects against death in patients with sepsis. The combination of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels has a better predictive value for death than any single measure alone in patients with sepsis.