Troponin can discriminate the most severe septic patients and should be included as an early routine test in Surviving Sepsis Campaign patients

Background

Myocardial injury can now be easily recognized in critically ill septic patients and is associated with increased ICU mortality. Troponin I is recognized nowadays as a highly sensitive and specific serum marker of sepsis-induced myocardial injury/depression and can predict outcome in the critical care setting.

Materials

In order to confirm this prediction power we included troponin I evaluations in our cohort of 100 patients within 24 hours of admission to our institutional protocol with strict adherence to the Surviving Sepsis Campaign guidelines within a tertiary care hospital, therefore eliminating heterogeneous population bias.

Methods

Cumulative survival curves were constructed using the Kaplan–Meier method and were compared with the log-rank test. Results were considered significant at P < 0.05.

Results

A total of 100 patients with severe sepsis/septic shock met the inclusion criteria and were evaluated during the study period. Demographic characteristics of the study population are presented in Table 1. Except for age, which was slightly greater in the positive troponin group, every other variable was not significantly different, rendering the whole group very homogeneous. Kaplan–Meier survival analysis within 28 days of patient inclusion is shown in Figure 1 as stratified by troponin positivity (>1.0 ng/ml). Troponin-positive patients showed significant increased mortality with a log-rank value of 0.0072.

Figure 1

Kaplan–Mayer 28-day survival curves.

Table 1 Demographic and clinical features of the study population

Conclusion

The elevations of troponin observed were mostly small to modest, reflecting minor cardiac injury, but they nonetheless presaged increased mortality very early in the course of the disease. Others have postulated that increased-troponin patients can probably benefit most from drotrecogin-α administration with mortality reduction, thereby rendering troponin determination mandatory in critically ill septic patients. Troponin should therefore probably be included as an early routine test in the Surviving Sepsis Campaign.