Cardiac Troponin I as a Marker of Sepsis Severity and Mortality Prediction
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- Category: Vol. 80, June 2012
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Cardiac Troponin I as a Marker of Sepsis Severity and Mortality Prediction,SALLY SALAH ELDEEN, MERVAT M. KHALAF and KHALED E. EL HADIDY
Abstract
Background: Cardiac troponins I (cTnI) are biomarkers that are currently used for diagnosis and risk stratification in patients with myocardial infarction and congestive heart failure, however, their prognostic and diagnostic impact in patients with sepsis syndrome need more clarification.
Aim: To study the prognostic value of cTnI on mortality and adverse complications in patients with sepsis and septic shock, and to study the relation of cTnI with ICU scoring systems.
Methods: A prospective comparative study was conducted on forty five patients admitted to the ICU with sepsis or septic shock. Then patients were divided into 2 groups; group 1: included 20 patients with positive cTnI (mean age 58±18.9yrs, 40% males) and group 2: included 25 patients with negative cTnI (mean age 52±19.3yrs, 64% males), comparisons between 2 groups were done according to all demographic, scoring systems, medications used and adverse outcome.
Results: Seventeen patients 85% of cTnI positive group vs. 36% of patients in cTnI negative group had severe sepsis or septic shock (p-value=0.001). There were statistically significant relations between the 2 groups as regards APACHE II (34.6±10.9 vs. 17.8±5.4, p-value=0.001), SOFA on admission (14.9±4.2 vs. 6.9±4.5, p-value=0.000 1) and SOFA at 2nd day (15.8±5.4 vs. 5.5±4.4, p-value=0.0001). The need for vaso-pressors was significantly higher in cTnI positive group than cTnI negative group (85% vs. 24%, p-value=0.0001). Mortality was significantly higher in group 1 than group 2 (90% vs. 60%, p-value=0.024). Cardiac troponins I was highly correlated with APACHE score on admission (r=0.71, p-value=0.0001), and with SOFA score both on admission and 2nd day (r=0.69, r=0.64 respectively p-value=0.0001). Only APACHE II and SOFA scores were found to be predictors of mortality in the study groups (p-value=0.0001), while Cardiac troponins I was not found to be predictor of mortality (p-value=0.29) by logestic regression analysis.
Conclusions: Sepsis patients with high cTnI levels are usually more critically ill and more prone to adverse outcome and mortality but cTnI level is not a predicator of mortality.