Elevation of Troponin T in critically ill septic patients is common: but does it matter?

Background

Troponin T (TnT) is an established marker of adverse outcome in acute coronary syndrome patients and aids risk stratification. Myocardial dysfunction and elevated of TnT are common in critically ill patients and cardiology advice is often sought.

Objective

To evaluate the role of TnT as a predictor of all-cause mortality in patients with severe sepsis/septic shock as defined by international criteria.

Methods

A prospective observational study was performed on patients admitted to a general adult ICU within 24 hours of the development of severe sepsis/septic shock. Serial TnT samples were taken over the first 96 hours. Patients were grouped into three groups: A, TnT < 0.01 ng/ml; B, TnT 0.01–0.099 ng/ml; and C, TnT > 0.099 ng/ml.

Results

Blood from 49 patients was analysed. The peak Troponin level was elevated (>0.01 ng/ml) in 39/49 patients (80%). There was no significant difference between the three groups in terms of hypertension, history of angina, myocardial infarction or systolic blood pressure at time of ICU admission. Patients with undetectable TnT levels (<0.01 g/ml) had significantly lower 6-month mortality rates than those with detectable levels (group A 2/10 (20%) vs Group B/C 23/39 (59%), P = 0.037; group B 8/15 (53%), group C 15/24 (63%)). See Table 1.

Table 1

Conclusion

Elevated biochemical markers of cardiac myocyte damage are common in patients with severe sepsis/septic shock. TnT elevation is a predictor of 6-month all-cause mortality. Clinicians should be aware of the significance of an elevated TnT assay in this patient population.