Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Frencken, Jos F.; Donker, Dirk W.; Spitoni, Cristian; Koster-Brouwer, Marlies E.; Soliman, Ivo W.; Ong, David S.Y.; Horn, Janneke; van der Poll, Tom; van Klei, Wilton A.; Bonten, Marc J.M.; Cremer, Olaf L.; de Beer, Friso M.; Bos, Lieuwe D.J.; Glas, Gerie J.; van Hooijdonk, Roosmarijn T.M.; Schouten, Laura R.A.; Straat, Marleen; Witteveen, Esther; Wieske, Luuk; van Vught, Lonneke A.; Wiewel, Maryse; Hoogendijk, Arie J.; Huson, Mischa A.; Scicluna, Brendon; Schultz, Marcus J.; Klein Klouwenberg, Peter M.C.; van de Groep, Kirsten; Verboom, Diana
• Is Part Of: Circulation. Volume 11:Issue 2(2018)
• Publication Date: 2018-02
• Subjects: infection -- intensive care units -- mortality -- sepsis -- troponin; Cardiovascular system -- Diseases -- Treatment -- Periodicals; Cardiovascular system -- Diseases -- Research -- Periodicals; Outcome assessment (Medical care) -- Periodicals; Evidence-based medicine -- Periodicals; 616.1007
• DOI: 10.1161/CIRCOUTCOMES.117.004040
• Languages: English
• ISSNs: 1941-7713

Abstract

Abstract : Background: Sepsis is frequently complicated by the release of cardiac troponin, but the clinical significance of this myocardial injury remains unclear. We studied the associations between troponin release during sepsis and 1-year outcomes. Methods and Results: We enrolled consecutive patients with sepsis in 2 Dutch intensive care units between 2011 and 2013. Subjects with a clinically apparent cause of troponin release were excluded. High-sensitivity cardiac troponin I (hs-cTnI) concentration in plasma was measured daily during the first 4 intensive care unit days, and multivariable Cox regression analysis was used to model its association with 1-year mortality while adjusting for confounding. In addition, we studied cardiovascular morbidity occurring during the first year after hospital discharge. Among 1258 patients presenting with sepsis, 1124 (89%) were eligible for study inclusion. Hs-cTnI concentrations were elevated in 673 (60%) subjects on day 1, and 755 (67%) ever had elevated levels in the first 4 days. Cox regression analysis revealed that high hs-cTnI concentrations were associated with increased death rates during the first 14 days (adjusted hazard ratio, 1.72; 95% confidence interval, 1.14–2.59 and hazard ratio, 1.70; 95% confidence interval, 1.10–2.62 for hs-cTnI concentrations of 100–500 and >500 ng/L, respectively) but not thereafter. Furthermore, elevated hs-cTnI levels were associated with the development of cardiovascular disease among 200 hospital survivors who were analyzed for this end point (adjusted subdistribution hazard ratio, 1.25; 95% confidence interval, 1.04–1.50). Conclusions: Myocardial injury occurs in the majority of patients with sepsis and is independently associated with early—but not late—mortality, as well as postdischarge cardiovascular morbidity. Abstract : Supplemental Digital Content is available in the text.