Abstract
Background
It is known that troponin elevations have prognostic importance in critically ill
patients. We examined whether cardiac troponin T elevations are independently associated
with in-hospital, short-term (30 days), and long-term (3 years) mortality in intensive
care unit (ICU) patients admitted with sepsis, severe sepsis, and septic shock after
adjusting for the severity of disease with the Acute Physiology, Age and Chronic Health
Evaluation III system.
Methods
We studied the Mayo Clinic's Acute Physiology, Age and Chronic Health Evaluation III
database and cardiac troponin T levels from patients admitted consecutively to the
medical ICU. Between January 2001 and December 2006, 926 patients with sepsis had
cardiac troponin T measured at ICU admission. In-hospital, short-term, and long-term
all-cause mortality were determined.
Results
Among study patients, 645 (69.7%) had elevated cardiac troponin T levels and 281 (30.3%)
had undetectable cardiac troponin T. During hospitalization, 15% of the patients with
troponin T <0.01 ng/mL died compared with 31.9% of those with troponin T ≥0.01 ng/mL
(P < .0001). At 30 days, mortality was 31% and 17% in patients with and without elevations,
respectively (P < .0001). The Kaplan-Meier probability of survival at 1-, 2-, and 3-year follow-ups
was 68.1%, 56.3%, and 46.8% with troponin T ≥0.01 ng/mL, respectively, and 76.4%,
69.1%, and 62.0% with troponin T <0.01 μg/L, respectively (P < .0001). After adjustment for severity of disease and baseline characteristics,
cardiac troponin T levels remained associated with in-hospital and short-term mortality
but not with long-term mortality.
Conclusions
In patients with sepsis who are admitted to an ICU, cardiac troponin T elevations
are independently associated with in-hospital and short-term mortality but not long-term
mortality.
Keywords
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Article Info
Publication History
Published online: September 30, 2013
Footnotes
Funding: None.
Conflict of Interest: ASJ has consulted or presently consults for most of the major diagnostic companies, including Beckman-Coulter, Alere, Critical Diagnostics, Radiometer, Amgen, Ortho Diagnostics, Abbott Diagnostics, and Roche, which manufactured the assay used in this study. The other authors have no conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
