Volume 12 Supplement 5

Sepsis 2008

Open Access

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

  • Constantino José Fernandes1, 2,
  • Nelson Akamine1,
  • Reinaldo Salomão2,
  • Luis Fernando Lisboa1 and
  • Otelo Rigatto2
Critical Care200812(Suppl 5):P13

https://doi.org/10.1186/cc7046

Published: 18 November 2008

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

Variable

Troponin level

n

Mean

Median

P value

Acute Physiology and Chronic Health Evaluation II score

All patients

98

25.20

25.00

0.2779

 

Negative

75

24.75

24.00

 
 

Positive

23

26.70

25.00

 

Age (years)

All patients

100

72.37

77.00

0.0185

 

Negative

77

70.45

74.00

 
 

Positive

23

78.78

82.00

 

Organ dysfunctions

All patients

100

2.91

3.00

0.6028

 

Negative

77

2.87

3.00

 
 

Positive

23

3.04

3.00

 

Mean arterial pressure (mmHg)

All patients

62

60,03

58.17

0.5152

 

Negative

51

60.24

58.33

 
 

Positive

11

59.06

56.33

 

ICU length of stay (days)

All patients

100

11.42

5.32

1.000

 

Negative

77

11.86

5.02

 
 

Positive

23

9.94

6.63

 

Lactate (mg/dl)

All patients

96

34.95

27.00

0.6717

 

Negative

73

35.03

27.00

 
 

Positive

23

34.70

26.00

 

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.

Authors’ Affiliations

(1)
Hospital Israelita Albert Einstein
(2)
Federal University of Sao Paulo (UNIFESP)

Copyright

© Fernandes et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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