Jos F Frencken1, Dirk W Donker2, Cristian Spitoni2, Marlies E Koster-Brouwer2, Ivo W Soliman2, David S Y Ong2, Janneke Horn2, Tom van der Poll2, Wilton A van Klei2, Marc J M Bonten2, Olaf L Cremer2. 1. From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands. j.f.frencken@umcutrecht.nl. 2. From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands.
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.
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.
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