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Prognostic value of elevated cardiac troponin I in ESRD patients with sepsis
Ea Wha Kang1, Hyoung Jung Na, Sug Min Hong
1Department of Internal Medicine, NHIC IIsan Hospital, Goyangshi, Gyunggi-do, Korea.
Insights
Elevated cardiac troponin I (cTnI) levels in end-stage renal disease (ESRD) patients with sepsis predict higher short- and long-term mortality. Monitoring cTnI is crucial for assessing adverse outcomes in this vulnerable population.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Elevated cardiac troponin (cTn) levels are known predictors of adverse cardiovascular outcomes in asymptomatic end-stage renal disease (ESRD) patients.
- The prognostic significance of elevated cTn in ESRD patients experiencing sepsis remains unclear.
- This study investigates the clinical implications of elevated cardiac troponin I (cTnI) in ESRD patients with sepsis.
Purpose of the Study:
- To determine the association between elevated cTnI levels and mortality in ESRD patients with sepsis.
- To evaluate the prognostic value of cTnI as a biomarker in this specific patient cohort.
- To inform clinical practice regarding the management and monitoring of ESRD patients with sepsis.
Main Methods:
- A cohort of 305 ESRD patients with measured cTnI was analyzed, with 121 developing sepsis during follow-up.
- Patients were categorized into elevated cTnI (ET, >0.2 ng/ml) and lower cTnI (LT, ≤0.2 ng/ml) groups at sepsis onset.
- Study endpoints included short-term (90-day) and long-term mortality, with survival follow-up.
Main Results:
- Median cTnI levels significantly increased from 0.05 ng/ml to 0.11 ng/ml upon sepsis onset (P < 0.01).
- The ET group exhibited significantly higher short-term mortality rates compared to the LT group (P < 0.05).
- Elevated cTnI independently predicted both short-term (OR 5.13) and long-term (HR 5.90) mortality, even after adjusting for confounding factors.
Conclusions:
- Elevated cTnI levels are significantly associated with increased short- and long-term mortality in ESRD patients with sepsis.
- These findings underscore the importance of monitoring cTnI levels in ESRD patients with sepsis.
- Elevated cTnI should not be overlooked and warrants close follow-up for adverse cardiovascular outcomes.
Background:
Elevated cardiac troponin (cTn) levels have been reported to predict adverse cardiovascular outcomes in asymptomatic ESRD patients. However, the prognostic value of elevated cTn levels associated with sepsis in ESRD patients is unknown. Therefore, this study aimed to elucidate the clinical implications of elevated cTnI levels in ESRD patients with sepsis.
Methods:
Of the 305 ESRD patients in whom cTnI was measured between January 2003 and December 2005, sepsis developed in 121 patients during follow-up. Based on cTnI levels at the onset of sepsis, patients were classified as elevated cTnI group (ET, n = 50, >0.2 ng/ml) and lower cTnI group (LT, n = 71, < or =0.2 ng/ml). Study endpoints were short- and long-term mortality. Short-term mortality was defined as death occurring within 90 days after sepsis, and patients who survived during this period were followed till death after 90 days.
Results:
Before sepsis, the median concentration of cTnI was 0.05 (0.01-3.59) ng/ml and it was significantly increased to 0.11 (0.01-22.0) ng/ml when sepsis supervened (P < 0.01). Compared to the LT group, the short-term mortality rate was significantly higher in the ET group (P < 0.05). After adjustment for age, diabetes, serum albumin and CRP levels, presence of shock and previous cardiovascular disease history, the ET group had a greater odds ratio of short-term mortality (OR 5.13, P < 0.01). In addition, the Kaplan-Meier plot for long-term survival revealed a significantly higher mortality rate in the ET group. In a multivariate Cox regression analysis, the elevation of cTnI levels was an independent determinant for long-term mortality (HR 5.90, P < 0.01).
Conclusion:
This study showed that elevated cTnI levels were significantly associated with short- and long-term mortality in ESRD patients with sepsis. Therefore, elevated cTnI levels in these patients should not be overlooked and be followed for adverse outcomes.
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