Elevated troponin in septic patients in the emergency department: frequency, causes, and prognostic implications
Joachim Wilhelm1, Stefan Hettwer, Markus Schuermann
1Department of Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany, joachim.wilhelm@uk-halle.de.
Insights
Elevated cardiac troponin (cTn) is common in sepsis patients in the emergency department (ED). High-sensitive troponin T (hsTnT) levels can indicate a poor prognosis, highlighting sepsis as a key differential diagnosis.
Area of Science:
- Cardiology
- Critical Care Medicine
- Emergency Medicine
Background:
- The "Third Universal Definition of Myocardial Infarction" criteria elevate cardiac troponin (cTn) levels above the 99th percentile of a normal population.
- Severe sepsis and septic shock frequently elevate cTn, but its role in emergency department (ED) sepsis patients is under-researched.
- Investigating elevated high-sensitive troponin T (hsTnT) in ED sepsis patients is crucial for understanding its frequency, causes, and prognostic significance.
Purpose of the Study:
- To determine the frequency of elevated hsTnT in emergency department (ED) sepsis patients.
- To identify the main factors influencing hsTnT levels in sepsis.
- To evaluate the prognostic relevance of elevated hsTnT in sepsis.
Main Methods:
- Adult patients presenting with sepsis to the ED were enrolled.
- High-sensitive troponin T (hsTnT) was measured upon admission.
- Factors influencing hsTnT and its prognostic value were analyzed.
Main Results:
- Elevated hsTnT was observed in 62.9% of 313 sepsis patients, with higher rates in severe sepsis and septic shock.
- APACHE II score, creatinine, and coronary heart disease independently influenced hsTnT levels.
- Elevated hsTnT showed prognostic value, with higher levels in non-survivors (AUC 0.72, p < 0.001).
Conclusions:
- Sepsis is a significant cause of elevated cTn in the ED, necessitating its consideration in non-acute coronary syndrome (ACS) patients with positive cTn.
- Elevated cTn in sepsis patients may serve as an indicator of adverse outcomes.
- HsTnT elevation is frequent in sepsis, even without renal insufficiency, underscoring its role in risk stratification.
Background:
According to the "Third Universal Definition of Myocardial Infarction", cardiac troponin (cTn) is defined to be elevated, if the value is above the 99th percentile of a normal reference population. Especially in emergency medicine, this leads to pathological values more often than before this definition has been founded. Severe sepsis and septic shock frequently cause a rise of cTn, but there is only limited data about its role in septic patients in the emergency department (ED). Therefore, we investigated the frequency, main causes, and prognostic relevance of elevated high-sensitive troponin T (hsTnT) in septic patients in the ED.
Methods:
Adults presenting at the ED with sepsis were included in the study. HsTnT was measured soon after admission. Main influencing factors were investigated, and the prognostic value was evaluated.
Results:
197 of the 313 analysed patients (62.9 %) showed an elevated hsTnT, with significantly higher rates in patients with severe sepsis and septic shock than in uncomplicated sepsis. APACHE II score, creatinine, and coronary heart disease were found to influence hsTnT independently. Nevertheless, patients with uncomplicated sepsis and without relevant renal insufficiency also showed notable rates of elevated hsTnT: 51.6 % (uncomplicated sepsis) and 34.5 % (no relevant renal failure), respectively. HsTnT showed a prognostic value with higher levels in non-survivors and an AUC of 0.72, p < 0.001.
Conclusions:
In the ED, sepsis is a relevant cause of elevated cTn, which underlines the role of sepsis as a differential diagnosis in non-ACS patients with positive cTn. A rise of cTn may be an indicator of poor outcome.
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