Role of admission troponin-T and serial troponin-T testing in predicting outcomes in severe sepsis and septic shock

Saraschandra Vallabhajosyula, Ankit Sakhuja, Jeffrey B. Geske, Mukesh Kumar, Joseph T. Poterucha, Rahul Kashyap, Kianoush Kashani, Allan S Jaffe, Jacob C. Jentzer

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15 Citations (Scopus)

Abstract

Background--Troponin-T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin-T testing in the prognostication of these patients. Methods and Results--This was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin-T and significant delta troponin-T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in-hospital mortality. Secondary outcomes included 1-year mortality and lengths of stay. During this 8-year period, 944 patients met the inclusion criteria with 845 (90%) having an admission troponin-T ≥0.01 ng/mL. Serial troponin-T values were available in 732 (78%) patients. Elevated admission troponin-T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin-T was associated with higher severity of illness. Admission log10 troponin-T was associated with unadjusted in-hospital (odds ratio 1.6; P=0.003) and 1-year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin-T and log10 delta troponin-T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin-T remained an independent predictor of in-hospital mortality (odds ratio 1.4; P=0.04) and 1-year survival (hazard ratio 1.3; P=0.008). Conclusions--In patients with sepsis and septic shock, elevated admission troponin-T was associated with higher short- and longterm mortality. Routine serial troponin-T testing did not add incremental prognostic value in these patients.

Original languageEnglish (US)
Article numbere005930
JournalJournal of the American Heart Association
Volume6
Issue number9
DOIs
StatePublished - Sep 1 2017

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Troponin T
Septic Shock
Sepsis
Odds Ratio
Hospital Mortality
Intensive Care Units
Mortality
Length of Stay
Comorbidity

Keywords

  • Cardiac biomarkers
  • Critical care
  • Sepsis
  • Shock
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vallabhajosyula, S., Sakhuja, A., Geske, J. B., Kumar, M., Poterucha, J. T., Kashyap, R., ... Jentzer, J. C. (2017). Role of admission troponin-T and serial troponin-T testing in predicting outcomes in severe sepsis and septic shock. Journal of the American Heart Association, 6(9), [e005930]. https://doi.org/10.1161/JAHA.117.005930

Role of admission troponin-T and serial troponin-T testing in predicting outcomes in severe sepsis and septic shock. / Vallabhajosyula, Saraschandra; Sakhuja, Ankit; Geske, Jeffrey B.; Kumar, Mukesh; Poterucha, Joseph T.; Kashyap, Rahul; Kashani, Kianoush; Jaffe, Allan S; Jentzer, Jacob C.

In: Journal of the American Heart Association, Vol. 6, No. 9, e005930, 01.09.2017.

Research output: Contribution to journalArticle

Vallabhajosyula, S, Sakhuja, A, Geske, JB, Kumar, M, Poterucha, JT, Kashyap, R, Kashani, K, Jaffe, AS & Jentzer, JC 2017, 'Role of admission troponin-T and serial troponin-T testing in predicting outcomes in severe sepsis and septic shock', Journal of the American Heart Association, vol. 6, no. 9, e005930. https://doi.org/10.1161/JAHA.117.005930
Vallabhajosyula, Saraschandra ; Sakhuja, Ankit ; Geske, Jeffrey B. ; Kumar, Mukesh ; Poterucha, Joseph T. ; Kashyap, Rahul ; Kashani, Kianoush ; Jaffe, Allan S ; Jentzer, Jacob C. / Role of admission troponin-T and serial troponin-T testing in predicting outcomes in severe sepsis and septic shock. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 9.
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abstract = "Background--Troponin-T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin-T testing in the prognostication of these patients. Methods and Results--This was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin-T and significant delta troponin-T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in-hospital mortality. Secondary outcomes included 1-year mortality and lengths of stay. During this 8-year period, 944 patients met the inclusion criteria with 845 (90{\%}) having an admission troponin-T ≥0.01 ng/mL. Serial troponin-T values were available in 732 (78{\%}) patients. Elevated admission troponin-T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin-T was associated with higher severity of illness. Admission log10 troponin-T was associated with unadjusted in-hospital (odds ratio 1.6; P=0.003) and 1-year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin-T and log10 delta troponin-T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin-T remained an independent predictor of in-hospital mortality (odds ratio 1.4; P=0.04) and 1-year survival (hazard ratio 1.3; P=0.008). Conclusions--In patients with sepsis and septic shock, elevated admission troponin-T was associated with higher short- and longterm mortality. Routine serial troponin-T testing did not add incremental prognostic value in these patients.",
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AU - Vallabhajosyula, Saraschandra

AU - Sakhuja, Ankit

AU - Geske, Jeffrey B.

AU - Kumar, Mukesh

AU - Poterucha, Joseph T.

AU - Kashyap, Rahul

AU - Kashani, Kianoush

AU - Jaffe, Allan S

AU - Jentzer, Jacob C.

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N2 - Background--Troponin-T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin-T testing in the prognostication of these patients. Methods and Results--This was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin-T and significant delta troponin-T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in-hospital mortality. Secondary outcomes included 1-year mortality and lengths of stay. During this 8-year period, 944 patients met the inclusion criteria with 845 (90%) having an admission troponin-T ≥0.01 ng/mL. Serial troponin-T values were available in 732 (78%) patients. Elevated admission troponin-T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin-T was associated with higher severity of illness. Admission log10 troponin-T was associated with unadjusted in-hospital (odds ratio 1.6; P=0.003) and 1-year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin-T and log10 delta troponin-T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin-T remained an independent predictor of in-hospital mortality (odds ratio 1.4; P=0.04) and 1-year survival (hazard ratio 1.3; P=0.008). Conclusions--In patients with sepsis and septic shock, elevated admission troponin-T was associated with higher short- and longterm mortality. Routine serial troponin-T testing did not add incremental prognostic value in these patients.

AB - Background--Troponin-T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin-T testing in the prognostication of these patients. Methods and Results--This was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin-T and significant delta troponin-T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in-hospital mortality. Secondary outcomes included 1-year mortality and lengths of stay. During this 8-year period, 944 patients met the inclusion criteria with 845 (90%) having an admission troponin-T ≥0.01 ng/mL. Serial troponin-T values were available in 732 (78%) patients. Elevated admission troponin-T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin-T was associated with higher severity of illness. Admission log10 troponin-T was associated with unadjusted in-hospital (odds ratio 1.6; P=0.003) and 1-year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin-T and log10 delta troponin-T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin-T remained an independent predictor of in-hospital mortality (odds ratio 1.4; P=0.04) and 1-year survival (hazard ratio 1.3; P=0.008). Conclusions--In patients with sepsis and septic shock, elevated admission troponin-T was associated with higher short- and longterm mortality. Routine serial troponin-T testing did not add incremental prognostic value in these patients.

KW - Cardiac biomarkers

KW - Critical care

KW - Sepsis

KW - Shock

KW - Troponin

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