Changes in High-Sensitivity Troponin Associated With 28-Day Sepsis Mortality

By Louise Gagnon

VIRTUAL -- November 3, 2021 -- Both increasing and decreasing levels of high-sensitivity troponin (hsTrop) are linked to sepsis-related 28-day mortality, according to a study presented at the 2021 Annual Meeting of the American College of Emergency Physicians (ACEP).

“Elevated serum cardiac troponin is a marker of myocardial injury associated with increased mortality in sepsis,” said Christopher Fung MD, University of Michigan Medical School, Ann Arbor, Michigan. “Increasing use of high-sensitivity troponin T in the emergency department has allowed earlier and more sensitive detection of myocardial injury in acute coronary syndromes but has yet to be studied in relation to sepsis.”

The current study included 763 adult patients who presented to the emergency department with a suspected blood infection and hypotension. Levels of hsTrop were measured in the emergency department and about 2 hours after. They measured the difference between the second and first measurements and stratified response by delta change.

Of the patients, 48 had a delta >6 ng/L, 54 had a delta ≤6 ng/L, 175 had a delta between -6 and 6, and 486 had no hsTrop delta obtained in the ED. 

In the weighted multivariable analysis and after adjustment for sex, age, and Charlson comorbidity index, both an hsTrop delta >6 ng/L (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.7-7.2) and delta ≤6 ng/L (OR, 2.2; 95% CI 1.1-4.4) were associated with increased mortality at 28 days. 

Patients with a delta >6 ng/L had an increased risk for early mechanical ventilation (hazard ratio = 3.0; 95% CI 1.8-4.9).

Older age and male gender were associated with both increasing and decreasing levels of hsTrop. Patients with a history of chronic kidney disease, congestive heart failure, and prior myocardial infarction were also more likely to had increasing and decreasing levels of hsTrop.

“Dynamic changes in high-sensitivity troponin obtained at emergency department presentation are associated with increased mortality in sepsis,” said Dr. Fung.

The authors noted several limitations to their study, including the relatively small sample size and possible selection bias due to non-standardised use of high sensitivity troponin assays.

[Presentation title: Dynamic Changes in High Sensitivity Troponin T Are Associated With Increased Sepsis Mortality. Abstract 376]