The results call into question the value of serial troponin T testing in patients with severe sepsis and septic shock, the study authors said. 

In ICU patients with sepsis, an elevated troponin T level at admission was associated with higher mortality, but changes in troponin T level during hospitalization did not provide additional prognostic information, a recent study found.

FINDINGS:

The retrospective cohort study included 944 patients with severe sepsis or septic shock admitted to ICUs at Mayo Clinic from 2007 to 2014. Ninety percent of the patients had an elevated troponin T level at admission (defined as ≥0.01 ng/mL). Elevated troponin T level was associated with older age, higher baseline comorbidity, and severity of illness. Both unadjusted and adjusted elevated admission troponin T levels (converted to log10 troponin T for continuous analysis) were independent predictors of in-hospital mortality (odds ratio, 3.3; P=0.003 for the unadjusted data and odds ratio, 1.4; P=0.04 for the adjusted data) and one-year mortality (hazard ratios 1.3; P=0.03 and 1.3; P=0.008, respectively).

RESULTS:

Serial troponin T values were available in 78% of the patients. Of the patients with elevated troponin levels, more than one-fourth had significant change (delta) between serial test results (≥0.03 ng/mL in three hours). The study found no association between change in troponin T levels (delta log10 troponin T) and mortality during hospitalization or within a year. Length of stay was not associated with initial elevation or change in log10 troponin T levels. The study results were published online by the Journal of the American Heart Association on Sept. 9.

“Prior studies on sepsis and septic shock have presented conflicting data on the association of clinical outcomes with troponin elevation,” the study authors said. They noted that the type of assay and the timing of testing differed among studies. The cause of troponin T elevations in patients with sepsis is still unclear, the authors noted. The study was also limited by being retrospective and conducted in a single center.

The results call into question the value of serial troponin T testing in patients with severe sepsis and septic shock, the study authors said. They also suggested directions for future research, including developing specific fluid and vasopressor strategies to treat patients with troponin elevation and imaging strategies to identify myocardial ischemia in patients with septic cardiomyopathy.